![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Entry tags:
First, they Came for the Smokers...
The continuing story of the sub-standard French breast implants, and whether or not they’re more likely to rupture than other ones, and whether (if they do rupture) they’re more likely to cause serious harm, has been playing out for some time. It’s a question that combines medicine and statistics in a way that I don’t feel I can (or particularly want to) comment on.
But I've been getting very uncomfortable about the way this has become yet another platform for those who wish to ration NHS care on moral (or, as they would no doubt say, "lifestyle") grounds. This kind of debate has come and gone many times over the years. Should smokers be treated on the NHS? Or people who choose to drink over 30 units of alcohol per week? What about people who have an accident when driving without a seatbelt? Or skateboarding? Or flipping pancakes while on the phone? Now there's a new group of people about whom to feel smugly judgemental: the women who have breast implants for - gasp! - cosmetic reasons. I've seen this line taken in several places, most recently this morning on Broadcasting House (forty minutes in).
I do think there's an element of misogyny here. The speakers seem so fixated on the motives for which the women got the implants in the first place that they seem unable to accept that the reasons they may need them removed are medical, not aesthetic. Someone in that radio clip mentions the analogy of tattoos, but the NHS won't remove your tattoo for you because you no longer like dolphins. On the other hand, if your tattoo becomes infected, you'll get treated for that. Is this a difficult distinction to grasp?
There's more to it than misogyny, though. Let's try this thought experiment. Imagine it turned out that a well known brand of lipstick was highly carcinogenic, and that it had given thousands of women cancer of the mouth. Would there be voices in the media loudly arguing that the women be refused treatment, on the grounds that they had only used the lipstick for cosmetic reasons? I doubt it.
I think at least two other factors are in play. First, fewer people get breast implants than use lipstick, and they cost a lot more. The sense that it is an unjustifiable extravagance - and that neither we nor any of our close friends would do it - will have put it above many people's prudery threshold. Second, the women involved have in almost all cases suffered no harm, so far. The removal would be because of the increased risk of rupture, rather than to treat the consequences of rupture. And there's a stubborn feeling in this country that preventative medicine isn't real medicine at all.
But I've been getting very uncomfortable about the way this has become yet another platform for those who wish to ration NHS care on moral (or, as they would no doubt say, "lifestyle") grounds. This kind of debate has come and gone many times over the years. Should smokers be treated on the NHS? Or people who choose to drink over 30 units of alcohol per week? What about people who have an accident when driving without a seatbelt? Or skateboarding? Or flipping pancakes while on the phone? Now there's a new group of people about whom to feel smugly judgemental: the women who have breast implants for - gasp! - cosmetic reasons. I've seen this line taken in several places, most recently this morning on Broadcasting House (forty minutes in).
I do think there's an element of misogyny here. The speakers seem so fixated on the motives for which the women got the implants in the first place that they seem unable to accept that the reasons they may need them removed are medical, not aesthetic. Someone in that radio clip mentions the analogy of tattoos, but the NHS won't remove your tattoo for you because you no longer like dolphins. On the other hand, if your tattoo becomes infected, you'll get treated for that. Is this a difficult distinction to grasp?
There's more to it than misogyny, though. Let's try this thought experiment. Imagine it turned out that a well known brand of lipstick was highly carcinogenic, and that it had given thousands of women cancer of the mouth. Would there be voices in the media loudly arguing that the women be refused treatment, on the grounds that they had only used the lipstick for cosmetic reasons? I doubt it.
I think at least two other factors are in play. First, fewer people get breast implants than use lipstick, and they cost a lot more. The sense that it is an unjustifiable extravagance - and that neither we nor any of our close friends would do it - will have put it above many people's prudery threshold. Second, the women involved have in almost all cases suffered no harm, so far. The removal would be because of the increased risk of rupture, rather than to treat the consequences of rupture. And there's a stubborn feeling in this country that preventative medicine isn't real medicine at all.
no subject
no subject
But it's only part of the argumenr, because the question of whether the NHS should remove the dodgy implants leaves out the role of the private cosmetic surgery industry, which has made good money out of selling the implants, and now seems to be incapable of supplying solid information about whether their removal will do more or less harm than leaving them in.
I say 'selling' because - well, you don't need to hear the arguments about how profitable it is to make women dissatisfied with their bodies. They are meeting a 'need' which only exists because they (and their allies) have created it. But if this were legally treated as a sale of goods, they'd be liable for selling something which was not fit for its purpose.
So I'd like to see them forced to help pick up the pieces...
no subject
I entirely agree with you about making money from, and encouraging, women's dissatisfaction with their bodies. But that's a far larger subject, which goes way beyond the cosmetic surgery industry.
no subject
It is complicated though and without better data, it's difficult to say whether there really is any danger from the implants at all. This could just be a hyped up panic.
The problem is, no one would disagree that a woman whose implant has ruptured should be treated, but should an already over-stretched NHS have to pick up the bill and find operating slots for people who are absolutely fine at the moment? And of course undergoing any operation involves risk from the anaesthetic and possible complications like deep vein thrombosis, so just saying, "The NHS should whip them all out!" isn't the answer either.
no subject
But do we expect a resort to pay for that? I'd expect (assuming this happened at Aviemore rather than Davos) the person to be taken to the nearest NHS hospital and treated there. After that, there may or may not be a case for prosecuting and/or suing the ski-lift operator, depending on whether they were at fault. Isn't that what happens in practice?
It is complicated though and without better data, it's difficult to say whether there really is any danger from the implants at all. This could just be a hyped up panic.
Indeed - and as I said at the top of the entry, I don't feel competent to comment on that aspect. That's a question of weighing up the likely risks, the potential damage caused by ruptures, the risks of the removal procedure, etc., none of which I'm in a position to assess.
no subject
In this case, any treatment that is required (in my view) ought to be funded by the people who profited by the original operations. Basically, I am just fed up of private businesses taking huge profits when things go well and evading their responsibilities and expecting the tax payer to pay when things go badly.
At the moment, as far as I know, these women are having no problems with the implants. Until someone raised the issue, I'm sure they were totally happy with what they'd had done. Nothing has actually changed. Only the perceived risk of something going wrong has changed. I therefore see no reason to spend money to remove them unless and until something actually goes wrong.
no subject
I have a lot of sympathy with this, but see no reason why it should be applied only to the cosmetic surgery industry, when other private businesses do the same thing on an even grander scale. The tobacco industry is top of my list, because giving people lung cancer and other illnesses, and indeed killing them, is an established side effect of the drug they sell, rather than something that occasionally happens when things go wrong. Putting the human cost aside, the economic cost of treating such people, losing their future economic production, and perhaps that of their carers, must be enormous - compared with which replacing a few faulty implants pales into peanuts.
Of course, it would be hard to sue Benson and Hedges for somebody's getting lung cancer, because you couldn't prove in any particular case that it was B&H's products that caused it, even though you know that in general, they do. For that reason a better model might be a punitive tax surcharge on all private companies that sell "risky" products and activities - from bungee jumping to Special Brew - calibrated according to the statistics for what people have cost the NHS as a result of that product/activity. That would be my suggestion, anyway.
I therefore see no reason to spend money to remove them unless and until something actually goes wrong.
Very likely this is right, but if (for example) we knew that a high proportion were very likely to rupture in the next five years, and that it would be much harder and more expensive to treat when that had happened, there might we be an argument (economic as well as moral) for doing it earlier. Without the figures, it's impossible to know.
no subject
Use every man after his desert, and who shall scape whipping?
no subject
People in my position too- I was lucky enough that mine, like Topsy, 'just growed', but not everyone is that fortunate.
no subject
no subject
As for why women get them, there are all kinds of reasons, but few are frivolous. Yet that's all you hear about on the media.
no subject
I hope it will all get sorted out - but it will take time, and it's not the kind of question that medical decisions should be made to hang on.
As for why women get them, there are all kinds of reasons, but few are frivolous.
Yes. 'Vanity' is a word too lightly used.
no subject
It probably is. It's a fine and subtle point that, judging from past experience with fine and subtle points, is probably beyond many people's capacity.
"Clearly they were at fault for using non-medical grade silicon - and if they still exist should be first in the firing line."
The company should be imprisoned for criminal neglect. (We have a saying in this country: "I'll believe a corporation is a person when Texas executes one.") Seriously, a company didn't do this: people did, and those people are probably still around.
no subject
no subject
no subject
I think we may disagree on the general principle, but I'd be interested in how far you take it. Would you be in favour of requiring tobacco companies to pay for the treatment of smokers who get lung cancer, for example? Or the drinks industry paying for liver transplants? Perhaps so - but I don't see anyone campaigning for that, while people are queuing up to complain about this far smaller, far less lethal problem.
Also, when you say you're opposed to non-reconstructive cosmetic surgery, I personally think that's a rather sweeping position (I'm in favour of letting people do what they like, unless there are compelling reasons not to), but also one that doesn't reflect the variety of reasons people might seek such a procedure. To take one example that was alluded to upthread, what about a trans women who is unable to develop breasts using hormonal treatments alone? It's clearly not a case of reconstruction, but are you happy to class it with a lunchtime botox session?
no subject
I would be asking whether that makes her any different to any other woman who is flat-chested. All humans come with nipples and some sort of underlying fat/gland structure to support them. Not all develop substantial boobs, whatever their gender of origin or affiliation. I'm not convinced that large breasts are anybody's right, or that it is appropriate to have surgery to construct them. I do see reconstructive surgery after mastectomy as different, in that it is replacing what was already there and thus limiting psychological damage from the cancer.
Whether this stands up to rigorous logical enquiry I'm not wholly certain.
no subject
Nor am I talking about large breasts, however you'd like to define them. There's a good deal of misinformation in the form of lurid redtop headlines about the costs and normal procedures in this and other areas related to transition, and also who pays for them, with sexualised references to "large knockers", etc. all being part of that discourse. If you're interested, I can point you to an up-to-date piece of research on the actual costs of transition (both ftm and mtf) in the UK, published within the last month.
If you're going to make an exception for psychological damage in the case of reconstructive surgery, you might also want to consider the psychological effect of implants in the case of trans women, who differ from flat-chested cis women in having a lifetime of being told that they aren't women at all, and whose condition is even now treated by the medical establishment as a psychiatric one (although this is controversial). I don't say it's a knock-down case, but then I don't think knock-down cases are to be had in this area. Drawing up the criteria for a panel to decide which women were worthy of being allowed to have breast implants, and which should be denied it on the grounds of vanity, would be a very difficult thing to do. As I don't believe in making other people's choices for them, however, I'm glad to say it's not my problem. :)
no subject
Hmmm. Do not like where that one was going either.
I tend to agree that the surgeons who implanted cut-rate prostheses probably do have a moral duty to do something about it. But in the end the NHS is there to deal with rupture, infection and serious risk. End of.
no subject
Hmmm. Do not like where that one was going either.
Agreed. I do hope he was saying that as a way of undermining the reconstructive/cosmetic binary, which (for reasons I've gone into above) I'm suspicious of too, but I suspect he was just stirring.
no subject
no subject
no subject
This is not an entirely theoretical business for me. I have two sisters who have had breast cancer, one of whom did have a double mastectomy not long ago -- she has not AFAIK yet decided whether to get reconstruction or not, and I am not discussing it with her unless she brings it up. Fortunately we don't carry either BRCA1 or BRCA2, but of course I still feel at much higher risk than others.
no subject
no subject