Staying abreast of the implant issue-Updated
Lance on Nov 19 2006 at 9:44 am | Filed under: Culture, Domestic Politics, Economics, Environment, Lance's Page, Law, Libertarianism, Media, Technology
The FDA which has finally decided to allow silicone breast implants back onto the market:
The decision appeared to end a controversy over the safety of silicone implants that lasted more than two decades and resulted in thousands of lawsuits by women who claimed the implants leaked and caused a number of diseases, including cancer and rheumatoid arthritis. The dispute led to the bankruptcy of the manufacturer Dow Corning, a federal moratorium on the use of the implants, and, finally, findings by both the Institute of Medicine and the Food and Drug Administration that the devices do not cause major illnesses.
Surveying the sparse reaction in the blog world I noticed Fersboo in the comments at Bitsblog asks a good question:
Will Dow get their money back?
Heh! I wouldn’t hold my breath, but in all seriousness the human cost of this has been quite large, and not just because of breast implants proven utility as an auto safety device:
A Bulgarian car crash victim was saved by her huge breast implants – which acted as airbags to absorb the impact.
It has been in all the major papers, but has resulted in surprisingly little commentary, though I believe it is a story with far more resonance when it comes to our actual liberty and our future as a free society than almost anything else we will read or discuss over the next few months. Why is it important? Two statements can give us a hint. From Breitbart:
The US federal government has given the beauty industry a long-sought push-up as it lifted a 14-year-old ban on women’s silicone breast implants, despite concerns by some experts they might not be safe.
And from Dr. Daniel G. Schultz, director of the F.D.A.’s Center for Devices and Radiological Health:
We have been looking at this data continuously for the last 10 years. We have been watching as data had been collected, we have been watching as data has accumulated. We believe that from a scientific standpoint, the decision that we’re making tonight is, in fact, in the best interest of American women.
Those two statements are pregnant with meaning. Both should worry all of us because of the mind set they represent. The first for the belief of many that because something might not be safe by some persons standard, which applies to every object or activity known to man, that our government has the right to decide whether we can have the object or engage in the activity. The second because Dr. Schulz, despite doing the right thing in rejecting the unscientific assault on a product millions of women want and by some standards even need, does believe it is his role to decide what is in the best interest of women. To really understand this issue I think we need to go into greater detail about what breast implants and the controversy surrounding them really represent?
We might start with Tammy Bruce, who is none too pleased:
Women surgically mutilating themselves to conform to a media and pornography-driven sick view of what a woman’s body should look like is bad enough. For the FDA to approve a device that even the agency admits is faulty and only ‘reasonably safe’ (whatyever that means), is absurd. But then again, the FDA is now more concerned with the health of pharmaceutical companies and medical profits than they are with the health of individual Americans.
I think the first sentence gives us the rationale for her, and many others, cosmetic surgery is immoral. A shallow surrender to the shallow values of our culture. “Safe enough” for something which is in and of itself objectionable just will not do if you believe our governments role is to decide what risks and trade offs are acceptable for its citizens to be able to consider. More than this is going on though, so let us examine the myriad ways that this particular procedure is wrapped up in the key issues which face us in the months and years ahead. Nor is my belief in this issues importance unique to me, though we are certainly a small group:
In the heady days of the Gingrich “revolution,” with Republican realignment one critical presidential election away, breast implants may seem both silly and dull a subject of interest only to bimbos and nerds. Very Important Conservatives, and their less important friends, have much more serious, much more interesting concerns.
Or so they think.
Breast implants are in fact neither dull nor silly. They are a lot more important than what sort of art the National Endowment for the Arts funds or whether it even exists. More important than a $500-per-kid tax credit or a capital gains tax cut. More important than the survival of the Commerce Department, the future of public television, or whether the U.S. embassy moves to Jerusalem. More important, in other words, than 95 percent of the issues that consume the conventionally wise on any given Washington day. To understand why, however, you have to think about a future beyond the New Hampshire primary, Internet hype, and next month’s mortgage payment.
That is Virginia Postrel in 1996, over 10 years ago. So let us go back to when the implants first were banned. In 1992 Virginia identified several places where the debate put pressure on divisions within our society. On a surface level she notes that the geographic division between places such as Southern California or Florida, “cultures of audacious self fashioning,” which are likely to see cosmetic surgery as “just another manifestation of the will to determine one’s identity,” and the trivial nature it may have in the eyes of a northeasterner.
More crucially we see a division between those who see health care as being driven by vital needs and those who favor a more pro-choice aspect to health decisions. Cosmetic surgery is almost always for aesthetic reasons, even when the issue is for reconstruction. It is due to the desire of the patient to look different, “not medical necessity.” As Public Citizen stated at the time:
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 health need, for these devices is the psychological benefit of having more perfect or larger breasts . . . . We do not accept that the psychological needs of women, who seek breast augmentation, are legitimate public health needs within the meaning of the {Food, Drug and Cosmetic} Act.
Note the implicit assumption. If we have a desire as consumer that does not fit some third parties definition of a ‘public need’ we do not just not deserve public funding, we cannot even choose to pay for such a thing ourselves or assess its risks and benefits on our own. Public Citizen is supposedly a consumer advocate, but they do not wish to enable or even allow us to make choices for our selves, but to make them for us with the government as its enforcer. Michael Wade here at A Second Hand Conjecture has warned of the political aspects which distort what types of research actually gets funded and the implication of ceding even more authority for such decisions to the political process, I fear even more what choices we will have denied us in the name of our own good.
This instinct goes far beyond breast implants, or even medical care. The environmental and public health movements have determined all kinds of things which are unnecessary from disposable diapers, oral contraception, tampons and toilet paper to our modes of transportation with little regard to what those various items and services might mean to how we fashion our lives. The trade-offs are always by some third party decision maker who may ignore the elements about those products and services that are most important to us in favor of the factors which they feel are most relevant:
Against this onslaught are arrayed the consumers who want to buy these products and the manufacturers who supply them. They try to explain what disposable diapers mean to a mother’s personal freedom or why outlawing juice boxes increases trucking costs and energy consumption. And, facing the FDA, we find women who want breast implants, whether for augmentation or restoration, defending their right to choose.
We have to give a “good reason” for our choices. For those of us concerned about the ongoing drug war, such as the recently deceased Milton Friedman, this is a key point. I have a close friend who often used to justify (despite ample evidence) his vote for Democrats on the Republican drug war. I argued that neither party was serious about doing anything about it, and that the most vocal opponents of it were certain Republicans and libertarians. My point was, how can you truly believe that a party committed to strictly medicinal drugs being heavily regulated to the point that they have to be proven both safe and effective would ever legalize recreational drugs. In a public health sense how could their use ever be justified by the FDA?
Some might find the analogy a stretch, but in addition to the jobs and billions lost by the owners, managers and employees of Dow Corning and other firms caught in the litigation and regulatory morass around breast implants; the careers ruined, the researchers who were humiliated and whose reputations were besmirched; we have stories such as this so reminiscent of drug prohibition:
On February 3, Houston-based U.S. District Court Judge David Hittner threw the book at convicted smuggler Delano R. Martin. Although the federal sentencing guidelines called for somewhere between 12 and 18 months, Hittner went above and beyond in punishing the criminal.”A sentence of 24 months should have a deterrent effect on the defendant and others unscrupulous enough to circumvent regulations intended to protect society, all for the sake of profit,” declared the judge, who also tacked on a $10,000 fine. Martin owes the Internal Revenue Service an additional $38,000 for income tax evasion.
Martin’s crime? Smuggling French-manufactured silicone-gel breast implants into the United States. Trade in silicone breast implants has been illegal since 1992, when the Food and Drug Administration, in a controversial decision, declared the medical devices a health hazard. (See “A Confederacy of Boobs,” October 1995.) According to the government, Martin illegally imported 47 implants in 1995 and has distributed close to 600 implants to doctors throughout the country.
Customs officials told the Houston Chronicle that the implants have become “a major commodity” on the black market, fetching more than $1,800 a pair.
Black markets, jail sentences, prices driven up and attracting the criminal element, the symptoms of denying people what they want based on the idea that what they want is a frivolous indulgence not worth the risks they have freely chosen is familiar.
Of course Postrel notes other divisions. The idea that women should even attempt to make themselves beautiful is a suspect desire to much of modern feminism. Naomi Wolf sees breast augmentation as “sexual mutilation.” This conflict over women controlling their bodies spill over to birth control, where some feminists fight against the pill which poses more possible health concerns (note the repetition of that phrase from the fight against breast implants) than techniques such as the rhythm method or other natural techniques. Tampons have been attacked over toxic shock syndrome and environmental waste. There are alternative treatments and products, they are not “necessary,” at least not in the eyes of their critics.
The third divide Postrel identifies is between medical practitioners and actual scientists.The evidence against implants has always been anecdotal. A woman has an implant and now she has a condition. To the doctor that may be evidence, to the epidemiologist it is meaningless. She quotes from Sociologist Eliot Friedson’s “Profession of Medicine”:
The consulting professions in general and medicine in particular encourage the limitations of perspective by its members through ideological emphasis on the importance of firsthand, individual experience . . . . Such emphasis is directly contrary to the emphasis of science on shared knowledge, collected and tested on the basis of methods meant to overcome the deficiencies of individual experience. And its efficacy and reliability are suspect.” Friedson notes that clinical practitioners often give expert testimony, generalizing from personal experience to conclusions for which they have insufficient evidence.
Needless to say, the doctor to a jury is an expert, and they have driven many products off the market, from toys and breast implants to drugs such as Bendectin and Vioxx. There has never been any credible evidence linking breast implants to disease, but the FDA has always been more attuned to the politics of the issue, and juries have handed out millions based on little more than assertion, though there too the FDA bears responsibility. By indulging the clamor for a ban they legitimized the legal assault in the eyes of juries. Once it went into effect the suits poured in and the enormous judgments followed. We have seen the same result more recently with Vioxx. The courts were so manipulated that companies not even directly involved, such as Dow Chemical lost in court for merely having conducted studies on silicon in a joint venture with Dow Corning. Silicone became more expensive driving up its price and the price of everything made from it. Medical devices which used silicone in other applications were withdrawn or rose in price to cover potential litigation.
The scientific consensus is overwhelming, as the New York Times pointed out in its announcement, though of course implant enemies are unimpressed as in this response to one scientific panel:
a leading lawyer/activist/implant recipient complained that the panel “had focused too closely on scientific studies and had not paid enough attention to the experiences of individual women.”
The head of the FDA at the time, David Kessler, was not impressed either with women weighing the risks differently than his agency:
If members of our society were empowered to make their own decisions about the entire range of products for which the FDA has responsibility,” he said, “then the whole rationale for the agency would cease to exist.
Of course he is right, but that hardly makes me view his decision any more favorably, just his agencies mission less so.
Breast implants are a special case however and that points to an even larger issue than we have really faced yet. They reflect, as pointed out earlier, a desire to alter ourselves, our biological state. That is a choice that is viewed with suspicion by those of many and various ideological flavors. Our medical establishment as well as our public health and environmental establishments see their role as determining and restoring us to “normal.” Nevermind whether they should have any real right or the ability to determine what a normal forest, cultural norm or bodily state is, that norm is what they exist to preserve. Improving is not in the agenda, and the idea that breast augmentation or other methods of “improving” ourselves is even a worthy goal is denied. Medicine is for curing or repair, not augmentation. Thus, even though it is almost always for aesthetic reasons, post mastectomy reconstruction is viewed differently.
As we move further and further down the technological path leading to greater and greater ability to shape our bodies, our minds, personality and even our lifespans we will confront these types of conflicts in ever increasing abundance. As disturbing as I find the breakdown in our regulatory and tort system in meting out justice, the ethical limits on our control over our own biological destiny are even more alarming if placed in the hands of technocratic elites and the activists who seek to control them. To quote Postrel again:
The body, not the Internet, is the next frontier. We are extending control over life itself, over our lives ourselves. That control will, undoubtedly, have some unintended consequences, and bring some tragedies. That is in the nature of things, the nature of life. But so is the attempt to better nature, to bring the born into the realm of the made, to assert human ingenuity against chance.
Technocracy is by nature hostile to diversity and freedom. Its goal is control–a uniform future shaped by experts. It recognizes only one best way. So it overrides the judgments and desires of individuals, curbing choice, experimentation, and learning in the name of “scientific” wisdom.Now, however, our technocrats aren’t keeping their side of the bargain. They’re destroying not only choice but progress, attacking not only liberty but truth. They have joined forces with those who seek to quash technology, innovation, and “unnatural” inventions–to create a static society by defamation and decree. By attacking the innocent and emboldening the malevolent, spreading rumors and defying their own experts, they have betrayed the public trust.
How we clothe ourselves, shape our bodies (through exercise or surgery) the objects and experiences we surround ourselves with shape and create who we are. The ability to choose how we live our lives is what makes us human, and the state limiting or taking away our choices limits what we as humans can be. Our identity, its biological and of course sexual aspects (normal sexuality has its own issues caught up in this as well) are intimately connected to how we look and feel. To trivialize it as shallow or superficial and thus within the purview of the state is quite dangerous, and flawed.
I remember at a young age hearing that mantra of the late sixties and seventies, “I want somebody who loves me for my mind.” This was supposed to show a “deeper” character than physical attraction. Even then I knew that was false. Intelligence is certainly a good thing to have, as is education, a good body or being funny. None of them show any moral depth however. The worth of human beings is not dependent on a sparkling personality or other characteristics, but far more humble virtues such as kindness. Yet we do not look down on somebody for admiring an intelligent or witty person. So things such as striving for physical beauty, however one might define it, is certainly nothing to look down upon. It is as legitimate a way to create who we are as any, and worthier than many. Nor should we allow those who wish to determine which aspects of ourselves are worth improving or augmenting any power to do so.
The implications however go further still. In previous essays I have argued that the recent outrage about our civil liberties being eroded are misplaced. I do not mean to imply that issues such as the warrantless wiretapping are unimportant, or worthy of serious debate. I do mean to say that they are not the largest or most prevalent threat to us as a free people. It is the very size and reach of the government. The story of how bogus science, zealous litigators and activist groups acting “on our behalf” limited our freedom, destroyed careers and fortunes is alarming, but it is part and parcel of the technocratic regulatory vision which animates the drug war, invades our privacy, and the privacy of how we chose to live our lives.
This state does not need a warrant, it has an a priori right to bend us to its will and affects literally millions directly every day. We have become so inured to this smothering blanket that we willingly part with information that a murder suspect would need a warrant procured in order to investigate. The very act of not turning over the information, say on our tax return, or to engage in political speech carries legal penalties, including jail time. After having been penalized for non compliance (regardless of guilt in any underlying crime) you have given the authorities license to obtain a warrant to actually determine guilt. As we documented earlier, even drinking beer in England is becoming subject to such invasions. Dow Corning, its shareholders and employees will certainly not get any compensation for their losses nor the women deprived of what they wanted and the unfortunate implant smuggler will not be compensated because the product should never have been banned in the first place.
In addition we have given the state the power to declare a huge number of things illegal, which if they were not illegal (such as importing silicone implants) the reason for even needing a warrant would be a moot point. Over vast swathes of our lives we have given the state a priori power to restrict us, with effects similar to what such an approach has on free speech.
Our property, our income and what we choose to spend them on, the treatments and services we indulge in are how we create our identity. A lack of security in owning and using them are the greatest threat to our freedom. It all ties in together. To artificially partition off some aspects of liberty as “civil liberties” which have primacy is to undermine the very nature of liberty and the basis upon which it can be maintained. The issues around breast implants go to the heart of these many issues facing us. Our complacency here threatens us far more than the Patriot Act, ask those who worked for or lost their savings in Dow Corning. As I said earlier, they will not be getting their money back.
Update: On the humorous side, Over at Chicago Boys, Jay Manifold finds the whole discussion uncomfortable, but in his comments we find this from Mitch Townsend:
I seem to recall that back in pre-internet days (meaning I can’t back up my story), an exotic dancer rolled over in bed and smothered her husband with her after-market modifications. Has the FDA looked into this aspect of the safety issues?
There was also a tax court case where a stripper deducted the cost of her implants as a business expense. The IRS maintained that they were a personal expense, not a business expense, and not deductible. The decision went down the middle: they were not a personal expense, since they were in fact an advantage in her work but a hindrance to her usual activities outside of work. However, since they were a modification or improvement of an existing structure, rather than a repair, and expected to either extend its useful life or enhance the income-producing capacity of an existing asset, they were a capital asset and the cost could be recovered through depreciation.
Whoever said being a CPA was boring?
Here is the link he provided to the discussion on this weighty (10lbs!) financial issue.
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The View From the Bluff: Lance’s Economic and Finance Blog
“…given the beauty industry a long-sought push-up as it lifted…”
Gee, Breitbart gets pretty preky over this story, eh?
Tammy Bruce needs self-righteousness-reduction surgery. She has a point, of course: These surgeries are vanity, and don’t make up for a lack of charm, wit, or underlying character. If the surgeries are ‘mutilation’, however, then so is any plastic surgery – regardless of reason. Plastic surgery, after all, is about improving our appearance, lying about our age, propping up our egos. Unlike Bruce, however, I choose to have compassion for those who undergo such surgeries. I’m not going to judge their motivations. Perhaps a man, turned down for jobs because of his age once too often, decides dealing with the perception is mission critical and opts for plastic work. An absolutely flat-chested woman might decide her dresses would just hang better if she had something to hang them on. There are any number of reasons, some wholesome, some not so, for getting plastic surgery.
As far as Dow Corning is concerned – yes, they were a victim. It is too bad they can’t get their money back. It’s also too bad that all the self-satisfied Bruce types who objected to the surgery on ‘moral’ grounds anyway found it is very easy to lay ‘mutilation’ as a finishing touch. Not only were women ‘victims of fashion’, a soulless mega corporation was ‘taking advantage’ of them, heartlessly forcing chemicals they knew to cause cancer into their bodies. Dow will neither be reimbursed, nor will they receieve apologies, as many who vilified it for so long have learned nothing and gone on to their next victim. Some, like Public Citizen (and maybe Bruce), choose to ignore the FDA’s conclusion and cling to a story that has served them for so long.
“To trivialize it as shallow or superficial and thus within the purview of the state is quite dangerous, and flawed.”
Well done. This sums up the link between the perceived ‘moral’ aspects of the procedure and the (just?) punishment meted out on its adherants (for Dow, bankruptcy, for users, death and disfigurement). This presumption is not only dangerous, but is in itself immoral.
Well said Mr. Snitch. Please stick around and see what else is here. It sounds like you will fit right in with our merry little band. I’ll check out your site as well.
They are not “silicon implants”—they are “silicone”. Confusing the element silicon with the chemical polymer known as silicone really detracts from your entire essay. It’s a really stupid error.
Thanks Tom for pointing it out. My apologies, posted at 4AM, no editor to read over it, and assorted other silly excuses. Now corrected.
Well done!
I’m an MS patient who has railed against the FDA (and the elite opinion you mention) for stifling innovation and chasing capital out of the pharmaceutical sector. I’m also a big fan of Ms. Postrel.
People’s attention wandered when I’d speak about Erbitux but You’ve found a hook that can grab and keep attention.
You’ve also written a smart and comprehensive piece. I couldn’t figure out the trackback but have linked. Thanks.
Bravo! I thought the ban was ill-conceived and a cave in to the anti-choicers. This is a beautifully written essay which well-defines the divide between freedom thinkers and totalitarian nannies.
My Psychology group project (Devry) for a class about 6 years ago was about this, at the insistence of a small busted asian girl in the group who I suspect had a personal interest in the data. At that time, it was relatively well supressed that there were two comprehensive studies from Scandinavian countries comparing incidences of connective tissue disorder (what they ended up calling the array of problems that were noticed in some women who had implants) between women who had implants installed, and women who had breast reduction surgery. I can’t find the paper just now so I do not remember if the study broke women into 4 or 5 age groups.
The results were so suprising that the trial lawyers succeeded in stopping the general release of the study to the public.
(Within the margin of error) the incidences of connective tissue disorder were the same for both implant and reduction groups. As might be suspected from that claim the reductions actually had greater problems in one age category and the implants in two (all three in the 3% error margin) and the rest were almost exactly the same.
What made those studies so significant was that although the elective surgeries are paid for personally, some of the recouperative costs were paid out of the respective countries National Health Care budgets and the detailed data was available for every single woman in the country. Unlike self selected volunteers, this let them pull a honestly random sample. I never did understand why they didn’t just fund a second “test” group of 100%.
Also I am a bit puzzled. At the time I did that report, the use of saline bags for elective surgeries was required, but the use of silicone was allowed, at the doctor and patient’s discretion, for medical problems such as reconstructive or repair of first time oopses. That meant that anyone who could afford it could just have two surgeries and get the silicone. Use a needle and pop the bag if the doctor does not agree that the first surgery was not quite right (although I did run across a couple of doctors who relatively openly ofered a double surgery price that figured on re-using the saline bags for consecutive patient for the lowered cost of that re-use. (it was less expensive to clean and sterilize the saline bags for re-use than to buy new bags each time).
If the silicone implants were delivered to a medical supply house selling to doctors or to the doctors directly, I dont see that half of the problem at all. After all, who but a doctor is going to implant those puppies anyway?
I suspect that the smuggling charge was for smuggled implants that had not been type tested or approved by the FDA. Not that much of a suprise. IIRC of the 5 companies making body implants (any type) at all, only 3 had any FDA approvals in the product line. And one of those 3 companies was not making breast implants at all. Penile pumps and saline bags for the pectorals, calves, thighs as well as something used in the face IIRC. And Dow was going out, had quit production, but was still selling existing supplies to the doctors who ordered the last ones.
So my guess is that the charge was smuggling in nonFDa implants, and the judge added to the penalties for the sheer evil of the silicone implant itself.
J’hn1,
Thanks for your personal experience. The allowance for their use in reconstructive surgery always struck me as odd. If they are dangerous for most of us why would they be allowed for reconstruction?
Probably goes back to two factors
1) a Medical Doctor decided it was appropriate. Doctors may recommend to patients treatments that have known risk factors, such as the carcinogenic organ anti-rejection drugs. (Every user gets cancer within 20-30 years, but if you don’t take them your body will probably reject the organs much earlier and you die even sooner) The reason they are not permitted that authority in elective situations is ???
Who Knows
Frequently reconstructions (as oposed to electives) involve different implant sizes on the two sides (Doctors likely pushed for every reconstruction “job” to go up in size as part of making the recipient less dissatisfied that she had to have the surgery in the first place, outside of a very few that involved reduction of the nonimplant side)(My recollection of the doctors showcasing their skills never once had a reconstruction matching the other unaltered side, the usual was increasing the one side a single size (to a size and a half, that absolutely isn’t carved in stone if the patient wants otherwise) and reconstructing the other to match and both to look nice. Color and size of dark area might be changed and protuberances might be relocated to match and look good. (trying to watch word choice in case young ‘uns read this)
2) the reason that silicone was the usual choice was it “felt better”.
More realistic.
Softer, yet less jiggley. The internal structure of a silicone implant more closely matches natural tissue. The saline bag is a water-filled bag. More rigid on the outside to give strength against leaks, while no internal structure to slow down mass transfer as it moves.
For reconstruction purposes, it was presumed that one side was relatively intact, and that the new side needed to match as closely as possible the feel (inside and out) of the natural breast.
For situations where they are putting in the same (or mostly the same) size in both sides, it probably shouldn’t be allowed that waiver (which is not the same issue as if implants should have been banned in the first place or even if it should be allowed now)In case anyone had trouble identifying my position, it is that implants should never have been demonized, and should be allowed now. They will never be made in the US again, or even by a US company due to US liability issues. And the new manufacturers will go through holy H-E-double hockeysticks in trying to get their products approved by the FDA as far too many people are still “on the warpath” regardless of the actual risk or relative safety of the devices.
One interesting customizable effect of the saline bags is that they are usually “installed” empty, (with much smaller exterior incisions) and filled to size in place. that means that the doctor can make them any size between minimum and maximum that he feels he needs to to have the two match exactly (which is reporedly not the case very often in Mother Nature’s version)(If Mother Nature didn’t give a girl an exactly matching set, she still wanted such a match when she left the Doctor’s office the last time which is why most saline bags can be added to afterwards)
J’hn1,
That all makes sense to me, I still don’t get why the reasoning doesn’t work regardless of the reason for the surgery, but as you said, “who knows?”
By the way, everybody should check out the update.
jk,
I checked out your blog and enjoyed it.
Thanks for the kind words. Don’t know if you saw the WSJ Editorial on this topic today. (That’s a $$$ link, I have a brief excerpt or I can email it to you if you like.
Please do, my office has ceased the online subscription and I haven’t read the dead tree version yet, nor can I excerpt it. I’ll check out your blog though while I await.
Actually, I’d really like a silicon implant. Can’t wait till I can manipulate a computer with my mind. The FDA will probably allow this procedure rather than silicone because of the group of who it helps. Computer chips in heads can help quadriplegics interact with computers and mechanical hands. Though whether the FDA would approve a similar procedure in a healthy human is up for debate. Silicone implants can help women everywhere who want them, but their cosmetic needs and wants are not seen as genuine.
ChrisB,
I am definitely for both. It was once said Bill Clinton had a CD-ROM in his head, a silicon chip is much less invasive.
[...] Um blog que eu não conhecia (a que cheguei pela Virginia Postrel), o second hand conjecture tece algumas considerações bem inteligentes. O post é longo, mas vale a pena. No fundo, resume-se a: 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 health need, for these devices is the psychological benefit of having more perfect or larger breasts… We do not accept that the psychological needs of women, who seek breast augmentation, are legitimate public health needs within the meaning of the {Food, Drug and Cosmetic} Act. [...]
Being a non-male and a non-American I find your argument interesting, albeit in an anthropological sense. The limitless freedom of personal autonomy seems to be the epitome of the good. It’s intriguing to me, as I come from a cultural background that does not exalt choice, but in fact decries it.
“Choice is the absence of freedom”, as a wise member of our human race, J. Krishnamurti once said, and can be interpreted to mean that individuals find more contentment when they have a moral core that weighs them down to their responsibilities and duties to others.
A woman who makes the “choice” to advantage herself with larger, more realistic-looking breasts is, as Naomi Wolf was aiming at, ultimately buying into the unhappiness that her culture is peddling. As for the “buyer beware” mentality of silicone implants causing health problems, it’s simply another sad example of the self-deception that hides behind the belief that we humans are individuals. When we ignore our nature as being one within a larger and more important whole, we make selfish decisions and gain self-inflicted wounds.
I believe that silicone is poisonous to the human body, as much as mutilation for vain ends is poisonous. Men are just as susceptible to the lures of vanity as women, and poison themselves just as often. I do not think that it is a person’s right to “choose” to debilitate themselves in the name of personal freedom, as their selfishness hurt them, and by extension, everyone. The same goes for people who own or invest in companies who offer these services; i have sympathy that they made mistakes and are paying for it, but they get no pity.
Limits on our personal freedom is a must, for it is a self-created limit. You realize it when you recognize that you owe others around you by your simple existence. And let’s not forget that burdens are what the universe gives us so that we can prove ourselves worthy and make ourselves happy. Difficulty is a blessing, because everyone has the ability to overcome it if they are truly good.
So speaks a small-titted chick.
Coelacanth (and let me congratulate you on one of the most original handles in the blogsphere), I agree with your points about vanity and self-mutilation.
Far, far too many people in the west (and increasingly the rest of the world) are image-conscious to the point of fanaticism. The ideal female look and figure, as pronounced by Elle, Vogue, Cosmo, or the Victoria’s Secret models, is about as natural as a three-headed dog. The female form (and, for that matter the male form) is at its best when it maintains a healthy weight (or for the health nuts, an acceptable BMI). For the majority of women, that weight is well over 100 lbs (45 or 46 kilos). For most men, over 150 lbs. I believe that your argument here ties-in with the rise of “instant gratification” culture, as well. Instead of working hard, dieting, and exercising to build a healthy body, the most image conscious amongst us instead opt for tummy-tucks, liposuction, collagen implants, etc. These voluntary surgeries really do amount to nothing more than self-mutilation in the name of vanity and lack of self-esteem. I believe that the same argument can be applied to the breast implant issue.
Having said all of that, however, I must disagree with you regarding individual liberty and freedom of choice. Choice is not the absence of freedom. Limits of personal freedom are not the solution, but rather the creation of another problem. I daresay that I’m going to sound textbookish here, but maximizing the choices offered to an individual and their personal freedom combined with maximizing their personal responsiblity are the keys to a better society. Now, the second part of that statement is the important one for this discussion. A woman (or man) should absolutley have the freedom to pay a surgeon to physically alter his or her body. That freedom should absolutely not be infringed upon. We must, however, continue to educate people about the unhealthy side-effects of such surgeries (both physical and psychological). Also, our society, as a whole, has got to move away from the media ideals that are foisted on us. The idea of a 90 lb, 5′6″ adult woman with 36 DD breasts is not only utterly unrealistic, but when you think about the methods used to obtain such a figure, quite disgusting. Such a woman is compromising her health and future for vanity and passing compliments. On the flip side, men who engage in 0 carb diets and use steroids to build their bodies up to unnatural proportions and achieve the remarkably unhealthy “ripped” look are also compromising their health and future for a mere ego boost.
It’s time that we get serious with this problem and I agree that we need to end this unhealthy obsession with comic-book figures (both male and female) and the mindsets that go with them. It’s a shame that all too many of the media figures who define the “perfect body” give only lip-service to solutions, but then these folks aren’t exactly known for their championing of personal responsiblity, are they?
Thank you for the compliment Omar (Khayyam?), I enjoy the metaphor of the Coelacanth.
However, the beginning and end of vanity does not exist in the vague sphere of “the media”, but rather in every individual’s misconceptions and insecurities. Television, internet, films, music etc., whatever medium compromises the media at large, is simply a mirror. It doesn’t actually have any self-existence. It’s more like a funhouse mirror that presents a distorted image of ourselves back at us. Actually, it’s probably more accurate to say that the media establishment is more like the human humonculous – except instead of sensory perception it emphasizes insecurity and fear.
The images of “ideal” bodies are only fantasies, yes, and only some very few and sorrowfully impressionable people fail to realize this fact. The vast majority are not influenced by these images. What they are influenced by, however, is the very real subtext of self-hatred. Many close friends of mine, and I’d be arrogant not to include myself to a certain extent, buy this idea hook, line and sinker. Mirrors are always illusory. There’s no need for them. If you seriously contemplate yourself, you realize that it is a very small and easy step to take to simply reject these fantasies. It’s such a trifling matter that it hardly needs discussion.
What the real matter at stake here is the idea of personal autonomy. The reason why I posted in the first place is because I am not an American, and I really find it astounding how much Americans – disclaimer: I take my opinion from what I gain of them mostly from the media i.e. CNN, The Atlantic Monthly, McSweeney’s Literary Journal, Virginia Postrel, Wilco – have internalized this idea as being an inalienable truth. I’d simply like to say that I don’t agree that it is, and in fact I believe it to ultimately be a detrimental idea.
Now, I am intrigued by what you said, that maximizing personal responsibility along with freedoms is key. I would agree, except for the fact that I am blind as to how the responsibility part has been accomplished. Responsibility is a self-limiting thing. No one can force you to be responsible; it’s an utter contradiction. the only thing society as a whole can do to keep individuals from using their “personal autonomy” to wreak pain and destruction on others (read: ENRON) is through the rule of law (read: punishment). If people are raised to believe that their own desires are paramount, therefore those who can evade punishment are technically “successful”, have no concept of responsibility to others. Inevitable conflict, crime and injustice ensues.
Would you not agree?
True, but
and people take the 24 hour mirror that they face very seriously.
Ah, but that’s the catch, isn’t it? Very few people in a nation of 300 million adds up to quite a large number. Many of those who do take the “ideal” seriously are the young and highly impressionable (teenagers and those in their early 20’s). These poor kids are so heavily misguided, in fact, that we have suffered from a national epidemic of eating disorders for the past twenty or more years. An average, WASP 16 year-old girl in the US is not going to take the message of maintaining a healthy, normal weight and look more seriously than the demands by her peer group (girls her age) and potential dating pool (boys her age). There is enormous pressure on young women to look a certain way. Those demands are reinforced twenty-four hours a day, every day of the year by the media in the US. You can’t turn on a TV or go to the movies without seeing Britney Spears, Hillary Duff, etc. and their size 0-2, midriff baring look.
Women in their thirties, forties, and, I daresay, fifties also face increasing pressure to maintain their youthful appearance and figures. Although the role models are different, the message is the same. Simply explaining to them that their real enemy is their own self-image is simply not effective. It must be reinforced by positive media portrayals of women with healthy builds (and non-cartoonish features [normal bust and hips, not grossly exaggerated, 36DD on 90 pound women]).
Ah, and here we come to the crux of the debate between libertarians and statists. You are absolutely right in that responsibility is almost entirely self-enforced. Statists believe that external authority in the form of the government must be used to enforce responsibility. Libertarians regard this as coercive use of force and instead believe that individuals should always own up to their own decisions and take the responsibility for the consequences of those decisions. Now the implementation of that philosophy is still very much in debate in libertarian circles (ask 10 different libertarians what their solution is and you will get 11 answers). I, for one, believe that responsibility and a moral framework are products of the home. Parents and, to a lesser extent, communities must take a much more active role in the upbringing of children to ensure that they learn basic morality and responsibility. A religious framework IMHO, certainly helps with this, but isn’t essential. If kids learn early on that their actions have consequences and that they will have to deal with those consequences, they will, hopefully, exercise better judgement later in life.
BTW, Coelacanth you are the first person, I think, to have caught the reference to the historical person that my handle is based on. Top marks!
I caught it Omar, though I was hoping the Ruby Yacht was in your possession when I met you. Oh, it isn’t really “ruby yacht” is it? So disappointing.
Lol, Lance. I should have figured you would.
Ahem! I got it too! Why do you think I give you so much grief for not rhyming? (heh!)
Again, coming at this from a clearly different background then yourself, Omar, but I have never heard the terms Libertarian and Statist ever used to describe modern sociological ideologies before. It almost feels like some eighteenth century political factions; Jacobites and Whigamores at it again!
I agree wholeheartedly about the importance of the home as the foundation of moral education, Omar. However, this idea seems less worthy of the name Libertarian rather than simply a re-wording of good old American pragmatism, courtesy of John Dewey.
Another point: I think you might be overcompensating a little bit with the media’s portrayal of women. Many women are thin. Have you ever walked through Les Limoges in Paris? Those chicks tend to be pretty thin. It’s no crime, beautiful is beautiful for men and women in any culture and class. There isn’t any pressure on women to look a certain way, women have more agency than that. I would know. I am a young student in the city and just about mired up to my waist in this media eddy pool. I see it everyday. I don’t care about it much, other than being annoyed at it’s ugliness.
As I stated earlier though, it’s self-hatred that’s being peddled, little else. If you can, upon reading this, pronounce that you are happy with your body and personality, then you are truly a non-conformist and a shit-disturber. And that’s all I could hope to be.
Lol, alright Michael! Bonus points to you, too. Just remember, finals are coming, and I don’t curve.
Boy, you did a lot of work on this, Lance.
I could, possibly, accept that silicone implants are actually safe and that they should be allowed to be sold in the US. I don’t know if that’s true, but it could be. I don’t have the knowledge to know, and this post does not provide it.
I don’t buy your larger argument, though. Unsafe products are rightly banned when they systmetically injure their users. And products that are banned for this reason are doing their companies a favor: in a functional justice system, if these products were sold instead of being banned, the liability incurred would probably bankrupt the companies in question.
Furthermore, the process of having a product fall out of favor through “market means” of having large numbers of citizens be injured or killed by the product is a model rejected by society, and for good reasons. How many consumers independently had the neccesary information and skills to know ahead of time that Vioxx was giving them heart attacks? None. And the evidence in that scenario is very strong. Merck is accountable for the deaths of thousands of people. Their lies and suppressal of information led as directly to innocent death as the no-knock raid in Atlanta.
So, if silicone implants were banned on a thin medical case, that’s too bad. It is, however, preferable for the company, the population, and society to err on the side of medical safety.
All the stuff about people who don’t like breast implants because they’re shallow is a red herring. The implants weren’t banned for shallowness. They were banned for safety reasons.
Whatever color the herring is, I think Lance is completely correct that the anti-choice brigades were able to conflate a small health issue with a larger public perception issue and get an essentially safe product removed from the market.
I also flatly reject your assertion about erring on the side of safety. I feel strongly that erring (red erring?) by the FDA should be on side of personal choice. Thirty thousand Americans died of Colon Cancer while the FDA did an extra two years of study on Erbitux.
Are we free to pursue our health care making our own decisions or not? I don’t see a government role at all. I have long argued for a switch to the UL/CSA/VDE model of independent private labs. This is good enough for hyper-regulatory Europe.
I am enjoying the discussion (and Omar, I got it too).
The tradition in America was that family, church, and local social pressure was applied to build personal responsibility. The left has consistently worked against these traditional forms of authority, in order to increase the importance of government.
There was no good evidence of significant health risks at any point in the debate. This issue has been well covered. Late 90s I was at a party with some Mexican ex-gang members, and they were well aware of the fact that the medical risks of these implants were bogus.
Consider Clinton’s rules on arsenic levels in drinking water: such rules would likely have resulted in more, not fewer deaths. Bush was correct to recind the Clinton EO on this.
Typically, there are risks either way. It is better to err on the side of freedom, and make people make the decision for themselves.
Wrong. There was never solid medical evidence to ban them on a safety basis. They were banned by a mix of feminists, lawyers, and government officials, and the “shallowness” played into it big time.
You admit you don’t know the science surrounding this issue; how can you claim to know the reasons for the ban?
I firmly agree with glasnost, the Thalidomide tragedy is evidence enough.
And jk, I think you wouldn’t suffer from a little Confucian education. Colon cancer is nature’s way of telling you that it’s time to die. Taking Vioxx should NOT be Merck’s way of telling you it’s time to die.
I have found that many people use the term “science” to mean “I am responsible to no one but myself” and “government” to mean “everyone but myself”. It’s strange. And depressing.
One could argue that any means of dying is “nature’s way of telling you that it’s time to die.” There is no clean dividing line between “natural” an “unnatural”. And “natural” is not always good.
Back in the late ’60s, some scientists predicted overpopulation and massive starvation. Science interviened to save millions, perhaps billions of people. The science was the Green Revolution, modern methods of agriculture. It isn’t “organic”, but if the world stayed “organic” massive starvation would have occured.
Don, you are another who aught to look to Confucius. The family is a microcosm of the state. The relationship between father and son; the relationship between ruler and ruled – one looks down to protect, the other looks up to respect.
The simple difference between our rulers and the Leviathan is that we choose them. They are us. “Thou Art That” in other words. When you attempt to limit the power of government and law, you indeed claim less agency for yourself and instead more burden. You have more decisions to make, with no guidance and in direct competition for resources even with your own brother.
You hurt others, you hurt the environment and you hurt yourself. That is the logical ends to obliterating the power of your father and by extension your government – and by furthest extension your God.
Coelecanth,
I appreciate your thoughtful comments, but I do have to disagree on several points and ask you a few questions about why you believe what you do.
Limitless freedom and personal autonomy sounds nice, but in actuality nobody expects that or considers it the epitome of the good. As for decrying choice, who exactly should decide when a choice is to be decried or not? Choices are made, it is just a matter of who makes them. Then, of course, we get to the question of who chooses the choosers? A world which respects personal autonomy may be imperfect, but history shows the suffering in those cultures which decry it is far worse, no matter how sophisticated the rationale for it is.
I have no problem with that, but exactly what does that have to do with personal autonomy? One can have a moral core without the decision made by the state. Not to mention that such a moral core can take many different forms, should the state decide which of those is acceptable?
Maybe, but how do you know? How do you know they are unhappy? Does that go for makeup or other efforts that a woman or man go to to make themselves look better? I would suggest some people (not necessarily you, though your discussion with Omar hints at it) who make such comments may be doing a little projecting. They are unhappy, so they assume that is another’s reason, but you don’t know really do you. Maybe it just makes you feel better to believe so? Might those women find you a bit presumptuous in so confidently claiming knowledge of their emotional and intellectual rationale’s, much less judging them? I don’t mean to sound dismissive, because I have made similar statements myself, I just refuse to arrogate to myself or others the ability to discern what the real reasons are or more importantly make decisions for people.
That doesn’t even begin to question the more “realistic” breasts aspect. If one is going to have such a surgery is less realistic a virtue? That seems odd to me.
That carries so many issues we will need to unpack it a little. You say our nature is being one with a larger and more important whole. I think it is fine to believe that, but it in no way contradicts that we are also individuals. Nor does it explain what the character of that whole we are part of is? Who should decide how we see that if not the individual? The state? If not, then that is an autonomous choice. I think it would be just as large a deception to claim that we are not individuals given the need for us as individuals to determine all the things you are saying make us part of a whole.
How is getting a breast implant selfish? Or, I should say how is it any more selfish because there are health risks? How do you know they are carrying a wound? I know women, healthy, happy women who have had them. I didn’t see the necessity, and questioned the motivation, but they have not wounded themselves in anyway that I can ascertain or on their mind at all.
Finally “buyer beware.” Given that every activity we undertake carries risk, many far more dangerous than breast implants, the question is who decides which risks are worthwhile and who does not. Your comment tells me that determining which risks are worthwhile should be shunted off to others instead of those who face them. Will they be wiser? I see little evidence that they are. What about the foods I eat? If an authority were to determine that organic foods carry a higher risk of bacteriological infection (which they do, and a far more serious health issue than breast implants) should they be removed from the shelves? Should all the misguided environmentalists who actually believe such food is healthier or is better for the environment (they are not on either score) have experts such as me deny them that choice? Especially given they pose a greater health threat than many drugs and treatments now denied or heavily restricted? I don’t think so, maybe you do.
Belief is one thing, but let us not pretend it is anything but that. There has been no evidence that silicone is poisonous. Your belief on that score may turn out correct, but you have no reason to believe it. Now that I think about it that applies to the second statement as well. Everybody does things for vain and shallow reasons, in fact most of what we do is whatever moral code we follow. We deceive ourselves when we pretend otherwise. You are merely substituting your own preferred vanity and superficial motives for others. I have no problem with that, we all do, just so long as it does not have the force of law. I also suggest it is best if one acknowledges that substitution up front. Self awareness is a responsibility of great importance as well.
So, if I think you are making choices that are harmful, I can forbid them? What about your diet, can I regualte that even though it might be an important part of your culture? If enough people (maybe one in some states) were to decide that vegetarianism was bad, could they force all of my friends from South India to eat meat? Never mind the accuracy of the belief (I am challenging yours about breast implants, so obviously people can disagree) by your logic I would have to forbid vegetarianism because I believed they were damaging to the whole of society. More ridiculous things have been done by people who believe they know best.
Of course the companies who offered these services did not do what you claim, so I think they deserve justice, but the state and the activists who drove them to bankruptcy with twisted science and misrepresentations (that many no doubt believed just as my anti-vegetarian example assumes) will not have to make whole these peoples lives.
That is all fine, but once again who chooses thiose “self created” limits? If James Dobson becomes President and decides those limits are radically different than what you wish them to be (and theoretically he would agree with most of what you say, though I think the results might be quite different than you would hope for since your rationale for state action could justify quite disparate courses) should he have the power to create them? What if his version of the greater whole allows little room for your cultural choices?
Who would deny that? That is in fact exactly the argument we are making. Nothing in this post, or anything by Postrel, implies that your personal autonomy extends to harming others. We are rejecting the idea that you can keep us from harming ourselves due to some rather subjective criteria that many would even deny is harming ourselves. You can think it all you want, it does not mean you have the right to enforce it.
Certainly no one here is suggesting our own desires are paramount, but they are important enough to enable us to make our own choices instead of you or who you support. Once again, the greatest injustices have always been by those who have taken that power of choice, not when we have more personal autonomy. You misread if you believe that we believe in no limits.
Actually it is quite libertarian. The home and individual decisions make up the culture and cultural choices. Not the state. Don has already covered this so I suggest you read Postrel’s The Future and its Enemies. You also should understand that Libertarian and libertine are not synonymous. One can be devoutly religious and have every view you have expressed and not have the state enforce them.
I agree, and please take the time to let them know that. That has little to do with this discussion. Responsibility means making choices however, others making them shows no responsibility at all.
As my example’s earlier asked, who chooses the father? The majority? If that majority attempts to force you to live a life that divorces you from that God isn’t that relationship broken? Who chooses that God and what its character is? The state that inhabits Confucious’ old home murdered tens of millions of its citizens with that power. All in the name of their vision of the good. The state is not my father, and Confucious, who I have read, was wrong. In a world where freedom meant little he was certainly to be preferred to many of his contemporaries, but the government is not a parent, and the government of Confucious’ time were horrendously abusive by any standard we might look at today, despite his pleadings for its wisdom.
Nor should you have the right to determine when I may say enough to how long I can live. I agree completely with Don that any lifespan above a fairly short time frame is “unnatural” if by that you mean we humans act in ways to prolong it. Without such action you would probably be dead now as would most of the worlds population. Taken literally the human race would die out. We would not disturb the world to even feed ourselves. You artificially categorize some things as natural and others as unnatural. No such distinction really exists. Every rice paddy, wheat field, apartment building or medicinal treatment is unnatural and requires human activity. Nor is my corpse any better off for having died from colon cancer as opposed to Vioxx (and by the way I deny you and glasnost’s characterization of Vioxx as well.) It is a far greater tragedy that the many millions have died due to delayed treatments than the few with Vioxx or Thalidomide, just as Jesse James cannot be compared to Stalin or Mao.
I should also point out that if your faith in the state as us, as our father is so profound, then why any complaint at the government putting them back on the market?
glasnost,
True, but the links do. You are wrong about Vioxx by the way, but I’ll debate the FDA later. I will say that erring on the side of safety still means we should err on the side of safety, not on the side of whatever people decide to demonize for “shallow” reasons. It also does not answer the question of how to define safe or compared to what and the benefits foregone. It also doesn’t answer the question of who should get to decide that.
Oh, and glasnost, for a point of reference where are you on the drug war?
Lance it’s true, it’s true. I have been using very obtuse language which obscures my point to an extent. In fact when I use the metaphors and references that I do, I mean to be criticizing cultural trends and conceptions as a whole. I rarely address single issues, simply because I don’t have the background information.
My overall intention, Lance, is to try to point out how much the opinions held by people who post on this blog are massively influenced by their times. The US, and some other affiliated countries, are living in a type of ideological bubble that has existed since 1945. I use the metaphor of a bubble to emphasize that the vast majority of the human population of the planet Earth are not involved in this ideology.
There is a lot of history and theory to explore, but in sum, the Protestant ethic and the spirit of capitalism (Weber) are inalienable to each other. We feel on this continent that we are individuals who have the ability to become wealthy/successful through cunning and hard work only because our freedom to do so is not infringed by the government, by religious institutions, or by other competing individuals with differing values. True?
Now, the nature of Protestantism has created this view. Without it, there would be no capitalism as we know it. Other aspects of Christian doctrine influence the American ideology as well: Providence (God’s favor) which has been secularized by such thinkers as Nietzsche and popularized by the writer Ayn Rand, linear historical development (events occur once, for a reason, and are not an example of a cyclical nature of the universe) which has been a reason why people have developed an ardent fear death, and the last, Monotheism – the is only one true reality and that reality is interpreted through doctrine, i.e. the beliefs and values of the society as a whole, in which individuality is one. Everyone who disagrees is wrong because there is only one God. Period.
Now, I have summed up in a crude and brief manner the major points that influence our way of thinking in these modern times. My point, as labored as it is, is that there is no reason to debate the role of government in a person’s life because it’s already been said (look up: J.S. Mill, Laissez-Faire policy, Benjamin Disraeli, Jeremy Bentham, John Dewey, Jonas Salk and you’ll get an interesting picture of our modern governmental policies).
American ideology inherently believes in it’s own universality. That’s the nature of the Protestant influence. That’s all. It isn’t ACTUALLY a universal policy. You believe that you are an individual who can and should be allowed to make your own decisions about your welfare and because of what I’ve explained, you think everyone else aught to be as well. Unfortunately, this is not the case. There are people who don’t believe in an “individual’s” ability to decide for themselves, and the individuals admit that they don’t want that responsibility. It’s simply another ideology. In this ideology, the government must protect individuals from potentially harmful products and services. Ideally, and this may not always be the case, the government is without bias toward the product and/or service because they don’t benefit monetarily from the sale. That’s why the privatization of public services, the FDA being one, is a mockery of unbiased opinion. I have the firm belief that the privatization of health care in the United States is one of the more depressing tragedies of the twentieth century, which is already a shameful disgrace of a century.
Yes, i do represent an ideology that is very much at odds with your own. But i don’t believe that there can be no reconciliation. It seems that almost everything you love about the modern era, I despise. Yet there is hope. We are essentially the same people, we have the same history and face the same challenges. And before there can be any real betterment of society, this reconciliation needs to take place. I’m trying to do my part, by reading this blog, and that of Virginia Postrel (who I have to admit comes to the conclusion that is the diametric opposite of my own even from the same situations). I’m trying to understand. If you would like to have a similar experience, pick up a copy of the New Internationalist magazine. That’ll be a kick in the ass. I don’t necessarily agree with everything they say, but it’s closer to my camp.
Good to talk.
I’d rather study success.
Wrong. There was never solid medical evidence to ban them on a safety basis. They were banned by a mix of feminists, lawyers, and government officials, and the “shallowness†played into it big time.
You admit you don’t know the science surrounding this issue; how can you claim to know the reasons for the ban?
I’ll tell you what, Don, you’re right. I don’t know the reasons for the ban. I should say instead that I find it hard to believe that shallowness played a major role. I base that on the fact that the cosmetic surgery industry in the US is in the middle of explosive growth. If the FDA was really making decisions based on feminist complaints of shallowness, I would expect a more consistent implementation of that.
It seems more likely that perceptions of the strength of the medical case differ.
This is false.
Historically, most socities have been warrior/agrarian. Societies that have had a chance to develop as merchant socities developed free markets and limited governments. The modern merchant socities have been Protestant (the US, England, Netherlands), but that was not true of the Italian city states that followed this pattern, or earlier merchant socities.
The US has been living under this “bubble” since it was an English colony.
Incidently, the outcome of the Napoleonic Wars was a result of the superiortiy of English “shopkeeps” and limited government over strong central government. WW1, WW2, and the Cold War all favored the superior side: the side with free markets and limited government.
There are typically unintended consequences to such protection, often resulting in worse results. It is better to leave the decision in the hands of individuals, for the same reason that markets make better decisions than central governments (consider the economic calculation problem and the fall of the USSR as an example of a result of that problem).
Historically, they have shown bias even absent “benefit”. And politcians have often obtained benefit from various dubious crusades. Implants are a case in point.
US healthcare was private to begin with, it wasn’t privitized. It has become increasingly socialized and regulated, and that is a tradedy.
US healthcare provides superior outcomes compared to Canada’s and England’s socilized systems.
If you think US healthcare is one of “the more depressing tragedies of the twentieth century”, you are ignorant of the twentieth century.
Coelacanth:
I’ve been following your comments here with some bemusement, and I’ve reached the conclusion that while you are an elegant writer you haven’t the foggiest idea what you’re on about. Judging from what you’ve written above, you seem to have simply adopted an ideology that affords you the luxury of feeling no guilt without ever examining the facts on the ground. To wit:
If you don’t have the information (which is confirmed by some of your ramblings — Nietzsche and Rand promoting the idea of “Providence”?), how can you possibly form a coherent ideology. What sort of approach to world is based upon little or no knowledge of what’s actually in the world? If you’ve already assumed what is there based on what your uninformed ideology tells you, you aren’t on a journey of discovery but one of confirmation.
Just to tackle one issue, the dichotomy you’ve raised between individuals and community (in the context of whom should be in charge) is certainly a long standing one, for which there is much historical development and empirical analysis. I suggest that check into some of it instead of assuming you know what’s there. Just for example, you seem to claim that “Protestantism” has created the following view:
We “feel”? [Plus, I thought you weren't American, nor on this Continent] This is not some vicissitude based on a religious belief or some cultist indoctrination. It is a matter of fact proven by history. That you contemplate such from a stance of “feeling” instead of fact says much about your ideology.
As another example, you say:
You don’t explain what “American ideology” is, nor how a hodge-podge nation with so many competing ideas (such your own, and ours here at ASHC) can possible have a singly “ideology” much less one that is “universal,” but more importantly, you seem to suggest that if the world is essentially made of those who want individual autonomy and those who don’t, the collectivists must be in charge. Why on Earth should this be so? You don’t say.
The government is without bias? Are you serious? You really believe that government officials have no bias towards any products, sales, companies, etc.? I hope you stick around for awhile and learn why this is a terribly naive view (you can start here and here, but we do myriad posts on this subject at ASHC). Suffice it to say that power creates much more bias than money.
BTW: This is just sadly misinformed —
Health care was not “privatized” in the U.S. It was always private until the government started meddling with it, making it much more inefficient and cumbersome today, than it once was. In fact, it is the socialization of American health care that makes it so bad (although in terms of actual care, it is still the best in world).
Finally, it appears that you have resigned yourself to living in a world where the government is inextricably linked to the individual’s life. That’s all fine and well if you have no personal desires or aspirations that conflict with the will of the government, but what happens when you do? How about when ALL of your hopes and aspirations conflict, despite the fact your accomplishment of those aspirations would harm no one, and indeed only help others? Moreover, you don’t identify any means of distinguishing “good” government from “bad” government, nor who gets to make that decision. As I said before, I hope you stick around awhile. Perhaps you will find answers to some of these questions.
Oh, and glasnost, for a point of reference where are you on the drug war?
I’m complicated.
Coward. ;^P
glasnost,
Instead of using feelings, try finding facts. I followed the breast implant thing all along, and from the beginning there was never any solid science presented to support a ban.
Consider this 1995 Reason article.
And this 1996 one by Virginia Postrel.
Here is a quote from the ‘96 one:
(and by the way I deny you and glasnost’s characterization of Vioxx as well.)
From Wikipedia:
The VIGOR (Vioxx GI Outcomes Research) study, which compared the efficacy and adverse effect profiles of rofecoxib and naproxen. (Bombardier et al., 2000), had indicated a significant 4-fold increased risk of acute myocardial infarction (heart attack) in rofecoxib patients when compared with naproxen patients (0.4% vs 0.1%, RR 0.25) over the 12 month span of the study. The elevated risk began during the second month on rofecoxib. There was no significant difference in the mortality from cardiovascular events between the two groups. Nor was there any significant difference in the rate of myocardial infarction between the rofecoxib and naproxen treatment groups in patients without high cardiovascular risk. The difference in overall risk was accounted for by the patients at higher risk of heart attack: those meeting the criteria for low-dose aspirin prophylaxis of secondary cardiovascular events (previous myocardial infarction, angina, cerebrovascular accident, transient ischemic attack, or coronary artery bypass). (Bombardier et al., 2000)
STRIKE ONE. (Caps only to make the count easy to find.)
…
Months after the preliminary version of VIGOR was published in the New England Journal of Medicine, the journal editors learned that certain data reported to the FDA was not included in the NEJM article
…
The editors charged that “more than four months before the article was published, at least two of its authors were aware of critical data on an array of adverse cardiovascular events that were not included in the VIGOR article.” This additional data included three additional heart attacks, and raised the relative risk of Vioxx from 4.25-fold to 5-fold. All the additional heart attacks occurred in the group at low risk of heart attack (the “aspirin not indicated” group) and the editors noted that the omission “resulted in the misleading conclusion that there was a difference in the risk of myocardial infarction between the aspirin indicated and aspirin not indicated groups.” The relative risk for myocardial infarctions among the aspirin not indicated patients increased from 2.25 to 3 (although it remained statitistically insignificant). The editors also noted a statistically significant (2-fold) increase in risk for serious thromboembolic events for this group, an outcome that Merck had not reported in the NEJM, though it had disclosed that information publicly in March 2000, eight months before publication.
STRIKE ONE + Fradulent intent.
In 2001, Merck commenced the APPROVe (Adenomatous Polyp PRevention On Vioxx) study, a three year trial with the primary aim of evaluating the efficacy of rofecoxib for the prophylaxis of colorectal polyps. Celecoxib had already been approved for this indication, and it was hoped to add this to the indications for rofecoxib as well. An additional aim of the study was to further evaluate the cardiovascular safety of rofecoxib.
The APPROVe study was terminated early when the preliminary data from the study showed an increased relative risk of adverse thrombotic cardiovascular events (including heart attack and stroke), beginning after 18 months of rofecoxib therapy. In patients taking rofecoxib, versus placebo, the relative risk of these events was 1.92 (rofecoxib 1.50 events vs placebo 0.78 events per 100 patient years). The results from the first 18 months of the APPROVe study did not show an increased relative risk of adverse cardiovascular events. Moreover, overall and cardiovascular mortality rates were similar between the rofecoxib and placebo populations. (Bresalier et al., 2005)
In sum, the APPROVe study suggested that long-term use of rofecoxib resulted in nearly twice the risk of suffering a heart attack or stroke compared to patients receiving a placebo.
STRIKE TWO.
Pre-approval Phase III clinical trials, like the APPROVe study, showed no increased relative risk of adverse cardiovascular events for the first eighteen months of rofecoxib usage (Merck, 2004). Others have pointed out that “study 090,” a pre-approval trial, showed a 3-fold increase in cardiovascular events compared to placebo, a 7-fold increase compared to nabumetone (another [NSAID]), and an 8-fold increase in heart attacks and strokes combined compared to both control groups [9] [10]. Although this was a relatively small study and only the last result was statistically significant, critics have charged that this early finding should have prompted Merck to quickly conduct larger studies of Merck’s cardiovascular safety.
STRIKE THREE.
Is three separate clinical studies showing more than double the incidence of heart attacks in Vioxx-taking groups enough for you Lance? Because there’s a few more in the article.
My father took Vioxx. If not for the FDA, he might be dead. At best, Merck committed criminal negligence on a massive scale.
FDA analysts estimated that Vioxx caused between 88,000 and 139,000 heart attacks, 30 to 40 percent of which were probably fatal, in the five years the drug was on the market
Boy, you did a lot of work on this, glasnost.
Oh wait, that’s plagiarism, sorry. Anyway, I still disagree with your characterization and your evidence doesn’t address my reasons. It was a generic comment to point out that I don’t accept your characterization of the issues there while keeping to the topic at hand. However, when I do next discuss the FDA specifically I’ll use it as a source. It’ll save me a lot of work.
As for your comment on the science behind the implants, Don is right, but it goes further. The FDA wasn’t listening to itself. Every study they conducted and scientific panel they called said the implants were not guilty of the claims made against them. This isn’t a close call. Kessler gave his reasons in my quotes above. The FDA’s own work was ignored.
Feeling and fact are the same, Michael.
And if you are accusing me of ignorance, I will be the first to agree. The more you know, the more you realize you do not, will not and cannot know. Re: The Good Brahman by Voltaire
I admit my summation was despicably brief, however, if you can understand Providence, you can understand the permutations it has gone through in the hands of Nietzsche, Nazi ideology and Ayn Rand. You will find it.
Speaking of Ayn Rand, I heard a quote of hers, being “Contradictions do not exist. Check your bases, and you will find that one of them is wrong”, and I paraphrase. I agreed with this at first. It seemed logical enough. But after a while and some serious thought, it became clear to me that this is one of the most widely held falsehoods in the modern world.
I admit I poorly phrased my above statement. I should have said ‘The fact that US health care is privatized…’ instead of ‘the privatization of…’. Please forgive a grammatical blunder. I am very familiar with the health care system in America. The care itself is far superior to anything I have available to me. I booked an appointment with a specialist in September for their first available time slot – in March. However, a friend of the family had been in and out of hospital struggling with Hodgkin’s disease for over 40 years. Never paid a dime. For this right I gladly pay taxes. Leaving millions out of reach of health care is the tragedy. The US is a bad place to be poor.
Back to Ayn Rand, if you understand why her statement is folly, then you have no reason to be upset with my musings.
Here is a 1996 Medical Journal of Australia article on implants.
Quotes:
(Note that they were banned in ‘92–prior to any real studies.)
Well, my dad was poor in the US and received quality healthcare.
And I had a close friend who was poor (working poor), and his newborn twins and wife received quality healthcare (the twins had significant problems at birth). My poor friend even got a bill for $100k or so which he didn’t have to pay.
I want to someone to show me the people in the US who don’t receive medical care. I don’t care about the theoretical possibility, I want to hear the reality.
“Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong.”
So Coelacanth, how is this a falsehood?
And, assuming it is, how is it “one of the most widely held falsehoods in the modern world.” It isn’t like many read Rand.
I think that a wider falsehood is that “thou shall not kill” is one of the Ten Commandments (properly translated it is “thou shall not murder”).
Another wide falsehood is the Marxist concept of Objective Value.
There are plenty of falsehoods, but I doubt anything written Rand comes close to being “one of the most widely held falsehoods in the modern world.” The biggest “falsehood” by Rand, however, is the principle of Non-Initiation of Force, which would result in anarchy if literally applied. Since Rand wasn’t an anarchist, it is a falsehood.
No, there really aren’t, Coelacanth. In fact, it simply does not make sense to say so. A fact is a fact, independent of any feeling about it. Water is wet no matter whether I touch it, look at it, hear it, smell it, taste it, or actively ignore it all together. The Sun is hot; 2+2=4; the Moon orbits the Earth; dinosaurs lived millions of years ago; the Nazi’s lost WWII; the Twin Towers came down on 9-11; socialism is anathema to freedom and liberty. These are all facts, not feelings.
Actually, that sentiment is properly accredited to Socrates (via Plato), and frankly you seemed to have missed the point of Voltaire’s story (it isn’t really human to forsake knowledge for happiness), but whatever.
You don’t seem to understand Providence, which is an external source of power and will. Nietzsche and Rand explicitly and emphatically reject any notion of external sources of power, and indeed flip that notion on its head.
That’s because you presuppose the ability of contradictory premises to exist. Just because you can think of it, doesn’t make it so. Humans do not create reality, we can only comprehend it. When we comprehend it honestly, we comprehend truth. Unfortunately, the Truth is often ugly and unsatisfying so we create fictions to mollify ourselves. Those fictions do not substitute for reality anymore than an actor can substitute for the real figure he portrays.
Fair enough.
There is no logical progression here, but instead a series of stated facts that do not support the conclusions. American health care is the best, but it sucks to be here if you’re poor? Why? As Don points out, poor people may not always have private insurance, but that does not mean at all that they don’t receive health care. I could go on about this at great length, but I won’t here.
I’m not upset. As I first stated, I am bemused by your ramblings. You seem to be entirely unconnected from reality and yet under the impression that you have a uniquely firm grasp upon it. You suggest that you are trying to be open minded about things, and thus you are visiting us here and reading Virginia Postrel, to which I say good on’ya, mate! If you are truly interested in expanding your horizons, please continue to visit, but don’t presuppose that we are ignorant of your views or naive in some way. Each of us here at ASHC has arrived at a similar philosophical place based on our own journeys, trials and tribulations. I think you’ll find that we have contemplated a great deal, and that our individual decisions to hold the individual as paramount in a system of government derives from a commitment to freedom and nothing else.
Such a skill is useful in debates; not so much for convincing others, but for continuing the debate no matter how much your ideas are shot down.
Years ago I argued with my mother-in-law about the ban on implants. For her, jury decisions in tort cases proved the point; all the science went out the window. For that matter, I suspect an FDA ban alone would prove the point for her. And the fact that implants were primarly intended to increase sex appeal by “unnatural means” were a major factor in her bias against implants.
I’ll quibble.
I view things like implants as a moral matter of individual rights, but free markets also have collective value. Free markets have won out, and proven superior to collectivist methods. The Napoleonic Wars, WW1, WW2, the Cold War and other examples come to mind (even the Mexican-American War). While this in theory is a secondary consideration, if in reality the Nazis or the Soviets prevailed, free markets would have become a quaint theory.
Americans tend to embrace pragmatic ideas: the bottom line, victory, success. Our success allows the Canadians to persue silly ideas, safe in the knowledge that Americans will provide military protection (and develope new medical techniques, etc.), while the Canadians look down upon the small minded provential Americans.
Sorry I am returning to this discussion late. Going back, oh about thirty comments to my original discussion with Coelacanth :
I’m going to assume, please correct me if I’m wrong, that you are of European, possibly French or British origin. Having spent some time in said nations, I’m not terribly surprised that you haven’t heard a great deal about Libertarianism or arguments against statism. The dominant mindsets of political leaders in Britain and Europe are so inherently under the sway of statist philosophy that discussing anti-statism or libertarian ideas with some of them would be like discussing sleeve length with a man with no arms. They have no relavant point of comparison and discussion becomes pointless and absurd. Books on libertarian philosophy published in Europe would sell about as well as a book entitled “How To Speak French” would sell in France. Although as regards the Jacobites, for some reason I’ve always liked Bonnie Prince Charlie and his rebels. Ah, the tragic glory of Culloden and the ‘45.
Lance addressed this issue more eloquently than I could have.
I confess that I spent a mere few days in Paris more than a decade ago. The highlights of my brief tour were the Arc de Triomphe, Les Invalides (I just had to see the Emperor’s tomb), the Louvre, Montmarte, Notre Dame, and, terribly embarrassingly, Euro Disney. I didn’t really get a chance to explore de toute beauté fleurs de France. Honestly, though, I’m much more attracted to the women of the global south (Africa, South Asia, and South America) than the heroin chic thin women of North America and Europe. The fuller, more feminine, Rubenesque female figure has always held more of an allure for me. As a rule, this look is much more appreciated by Middle Easterners, Africans, Indians, and South Americans than by the global North.
Then I certainly admire your character and compiment you on your confidence and positive self-image. I suspect, however, that most young women (and some older women, as well) do not have the level of maturity and confidence that you do. These are the ones so easily manipulated by the lies fed to them about certain “looks” by the media. I am entirely out of the realm of statistical evidence at this point, but I would suspect that if offered the opportunity to look like Julia Roberts or Angelina Jolie, most American (and possibly British and European women, as well) would jump at the opportunity. While their actual looks and figures may not be ideal (I find both to be unattractive, and I don’t just mean their builds), the way that they are portrayed by the media leads far too many women to believe that they do represent an ideal.
Lol! Jolly good. I have the fortune of having been an athlete in my teen years. Since then, I’ve become an academic. While not incompatible on some theoretical level, in practical terms “athletic academic” is an oxymoron. Oh, except for the jogging nuts in the business college, but we of the humanities don’t associate with riff-raff like that.
As a perfect example of the great divide between the “athletic” and the “academic”, Terry Pratchett’s depiction of the faculty of Unseen University is about the most damnably accurate description of a liberal arts faculty as I’ve ever seen. Fat, bearded professors in funny clothes struggling to determine their actual purpose and duties at the university during the process of consuming seven course meals while generally mucking up the entire educational system and causing great irritation to the students and administrative staff.
Hmmmm,
I am no longer an athlete (blew out my knees) and I decided to end being an academic (though that was the path I was on at the time)but I easily could have been an athletic history professor. I am pretty happy with my body, though if I got any exercise at all I am certain I would be happier. Does that mean I fall short? Should I be labeled because I could look better? The thing is I don’t care much (or I would do something about it) but I am pretty sure I don’t consider that a virtue. I will say that I do miss being able to dunk, or even grab the rim.
Even if hired, you’d have been shunned. An outcast. A “fit” amongst the “fat.” Worse, they’d have made you the delegate from liberal arts to all those faculty senate meetings. No worse punishment can I imagine.
Michael, I love you, you’re hilarious! But there is simply no way forward in our relationship if you cannot bring yourself to agree with me on that first idea. There is no objective reality, hence no facts. There is no reality outside of human perception – and when I say this I mean reality that can be discerned with the senses, there is very much the reality of the ineffable, in my opinion.
That story by Voltaire yields more than the surface argument of ‘ignorance is bliss’, really, that man was a genius. And where could the idea of the Ubermensch of both Nietzsche and Rand come from if not of Providence? To believe that some individuals were born of higher esteem and worth and ability than the muddle about them by pure and utter chance is a little silly, right? They had to come from somewhere. The irony of the innate theism of two self-declared atheists strikes me as funny. It’s hard not to laugh at those authors. They said important things; important, laughable things. They were “rationalists”, and don’t get me started on rationalism. Wow. It’s dumb. And the fact that most rational institutions are founded on the most irrational concepts is more of the funny, contradictory nature of human beings. We are all silly and vain our hapiness and angrer are often totally arbitrary. Look at Chuang Tzu, he laughed at us all the time!
You and me, Michael, we truly are talking about the same things. Honestly, we are. We just approach from different angles. Have you read Robert Pirsig’s masterpiece Zen and the Art of Motorcycle Maintenance? He outlines the duality of Western thought into two categories, which we both clearly represent, and attempts a reconciliation of them, using the metaphor of bike mechanics. Great story.
I don’t think you’re stupid or ignorant! That would be a tall order for a twenty-one-year-old on, what I presume to be, her superiors. I use obtuse language because of an early penchant for nineteenth-century novels (Omar: Robert Louis Stevenson’s Kidnapped is when I learned about Culloden and the Bonnie Prince – Alan Breck of Stewarts is my highland outlaw boyfriend!). All that I have aspiration to do is make the humble point that many people, myself being one, do not think the way you do, and hopefully to also express that we have a valid reason for doing so. I began writing on this blog with the maxim of “Keep your friends close…” in mind, but have come to change my opinion. You are not enemies of mine as much as opposing political parties are each other’s enemies.
We are ideological opponents, but we strive for the same goals. Unless, of course, you are striving for the detriment of human society then we really are on different pages. But I doubt that this is your intention. My friends say: “Why do you post on that stupid blog? Leave those right-wing Nazis alone, they eat babies.” I don’t agree with my friends, my friends are morons, but they do express the sentiment that this silly partisan duality incurs. It’s worthless.
But don’t get me wrong. I really, really think that some of your ideas – often more clearly outlined by Virginia Postrel – are detrimental to human life. The only reason I found this blog was a link from the Dynamist, the address of which I found at the end of her article in Atlantic Monthly. I searched it because her article made me vehemently angry. She was praising chain stores in their blank-eyed, brainless, frenzied swarming across the world like locusts. It was amazing. To actually argue in favor of the senseless burning of cultural artifacts and rituals in the name of “convenience” and “lower prices” boggles the mind. I am boggled. When it’s all over, there won’t be a scrap of identifiable rubble remaining – in our land and in our souls. We must look to the future, and the only way to do so is to see the limits. We must limit ourselves, now. We must limit progress, production, freedom, science but not thought.
It’s complicated. I can’t really say it all here. I’m sure Michael will have a field day. Please do, by all means. However, I must bow out. It’s exam season and there are exams in the air. Don’t stop the talk.
PS Omar yer cool. Rock on Rubenesque!
PPS This is a nod to the fact that I am not British or French (I would be more eloquent if I were). This is from your quiet buddy from the north. We know and see all up here north of the 49th, and we have our humble opinions.
Yes, but your worldview only leaves us with opinions. Worthless ones at that, aside from fodder for coffieshop discussions.
The people who believe in reality are the people who make the future. Your philosophy leads to an empty, hopeless place. When you grow up you will adopt a pragmatic philosophy, assuming you in fact learn from life experience.
How ironic. Your view is what’s detrimental to human life. You present the same attitude that would have prevented the Green Revolution (and may prevent the next one, resulting in massive starvation), the attitude that banned DDT, the attitude that would destroy us if generly accepted.
It’s always a thrill to be appreciated by the younger generation.
Oh, good Lord, you’re Canadian?!? That burdens you with the baggage from both the Brits and French. Mon pauvre enfant! How do you bear it? Lol. Just kidding.
Yes, and as I’ve pointed out to my co-bloggers, I don’t curve, so prepare thoroughly. Please come visit us again after the stress of exams is over. And good luck!
Coelacanth:
Well you were right about one thing at least:
I am pretty frickin’ funny.
OK, fine. Two things.
So you have changed your mind about me, huh? Compare to:
I knew it. You suffer from geek-envy.
J/K
oh, so NOW I’m the enfant, eh? You can call me the Illustrious Infanta! Officially the last post ever!
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