A woman's right

When it first emerged, feminism had a coercive tone. Think of Simone de Beauvoir. The French thinker determined that allowing women to stay home, instead of going to work, would imperil the women's movement. Women, she argued, "should not have that choice, precisely because if there is such a choice, too many women will make that one."

But these days, and especially in America, official feminism has made its watchword: "Choice, 24/7". Negotiations over the cosy minutiae of workplace choice - from flexitime to day-care options - consume the office day. Then there is the abortion controversy, entirely defined by "choice". Back in the 1970s, abortion rights activists claimed the label "pro-choice" for their movement. It proved such a winner that the anti-abortionists, the "pro-lifers", have never recovered.

All the stranger, then, to find America's leading feminist organisation rallying its allies in a campaign to deny individual women a choice that could not be more personal. The choice involves silicone breast implants, whose safety the Food and Drug Administration will consider in coming months. This month an FDA-appointed panel recommended that the agency permit the use of such implants after a decade's ban. A final decision allowing routine use would represent an unusual reversal.

The prospect of restoring to women the silicone choice has infuriated the National Organisation for Women. In July, it staged a press conference at the National Press Club at which women- conscious health and consumer groups called on the FDA to delay review of the devices' safety. Later Senators Mary Landrieu, Barbara Boxer and Dianne Feinstein wrote to Mark McClellan, FDA commissioner, asking him to halt review.

To understand this battle, it helps to go back 15 years. At that time, thousands received silicone implants, mostly to augment breasts or for reconstruction after cancer. Some subsequently fell ill, sometimes with life-threatening diseases. A percentage blamed the implants.

Even without proof, there were enough anecdotal horror stories to give impetus to what was then the largest-ever class action suit. Lawyers sought billions in the names of more than 400,000 women. The wave of litigation was more than sufficient to topple Dow Corning, the implant maker - although it went down howling that both it, the company, and silicone, the substance, had been wronged. The FDA for its part banned the routine use of silicone implants. David Kessler, then commissioner, even publicly castigated the American Medical Association for publishing a report saying silicone might be acceptable.

The ban had unwelcome consequences. The first was that healthy customers set on breast augmentations had to accept saline implants, deemed less natural- looking and generally inferior by both the women and their surgeons. The second was to deprive - at least officially - tens of thousands of women who had undergone mastectomies of a reconstruction with silicone implants. Many of these women lost the benefit of a device that might have helped restore them to their natural appearance.

Over the 1990s, some things came clear. Instead of eschewing implants, more and more American women were seeking and getting them: by 2002, the number of breast augmentations in the US had risen sixfold in a decade. As for the reconstruction candidates - who numbered 74,000 in 2002 - they and their doctors were often determined to find ways to get silicone. Mastectomy patients entered a national research study solely because it gave them access to silicone implants.

The next bit of news was that silicone breast implants, like saline ones, did cause some problems. They moved. They hardened and became uncomfortable. They ruptured. After 10 years or so, they needed replacement.

But the final insight of the 1990s was that implants were not killers or even triggers for more serious disease. This was not a latter-day equivalent of foot-binding. In the UK, the Royal College of Surgeons cleared them. In the US, the Institute of Medicine did the same. This scientific consensus explains why the advisory panel has recommended that the FDA consider making implants generally available. It also stipulates that Inamed, the current maker of implants, should educate the consumer thoroughly.

A more enlightened, pro-choice direction for the FDA to take is hard to imagine. But it is also hard to imagine a more intrepid one. In even entertaining the idea that women may take their own risks, the FDA, and especially Mr McClellan, a Republican, have bravely let themselves in for abuse that can only escalate with the presidential election campaign. This despite the fact that in life there are all sorts of risky behaviour - bungee jumping, the piloting of single engine planes - that we view as acceptable.

To be sure, as many will argue, plastic surgeons and implant makers are acting out of base financial motive. But then so are ski resort owners and motorcycle makers and US abortion clinics. And if you take the pro-ban argument all the way, you concede that "anecdote plus emotion and politics" will suffice to decide a women's matter, for in women's issues, data matter less. You are also saying that women may not be up to making big, scary decisions. Most of us recognise that these statements are not true. In any case, they are not pro-choice.

© Copyright 2003 Financial Times

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