NY Times Identifies Breast Implants as Annuity Medicine
What is “annuity medicine?” Annuity medicine refers to the fact that once a patient walks into a doctor’s office, the doctor gets an annuity because he knows the statistics that will bring her back for operation after operation. She becomes his insurance policy for a great practice.
Well, three cheers for the New York Times for identifying breast implants, the most popular cosmetic surgery in this county, for what it is: annuity medicine! Today, the venerable newspaper published an important and timely article on the front page of its Fashion and Style section, which brings some much-needed attention to the many important issues around breast implants, issues that have largely disappeared from the public discussion. The article’s focus is on the ongoing financial costs of breast implants, which is very appropriate as American families feel the pinch of a slowing economy.
“Do My Breast Implants Have a Warranty?” by Natasha Singer, starts by questioning the marketing around breast implants, which often makes light of what is still an invasive surgical procedure and sends misleading signals about what women should expect. For example, one ad that appeared in Elle magazine makes an analogy with diamonds, which may “last forever” but implants most certainly do not. The rest of the article talks about the high complication rates associated with implants, their need to be replaced, and the financial burden all this represents. Women getting breast implants often don’t realize that they will have to keep paying after investing in their first pair:
But with such high rates of reoperation, a new debate is emerging over whether breast implants constitute the kind of annuity medicine that will entail regular surgical tuneups, exposing patients to increased medical risk and out-of-pocket expenses. At a time when manufacturers have provided the F.D.A. with clinical studies that follow patients for just a few years, there is no established medical consensus on how long implants last, leaving doctors to rely on their anecdotal experiences when discussing durability with patients.
(italics, mine)
The article also touches on important issues around breast implants, such as the limitations of the research (here, concerning their durability, but which is the same research supporting the “safety” of this medical device) and why “informed consent” is problematic.
About the research:
“The short answer is, we don’t know specifically how long implants last,” said Stephen Li, the president of a medical device testing company in Sarasota, Fla. Dr. Li, who has served on three of the F.D.A.’s panels that reviewed implant safety, voted to approve silicone implants. He said manufacturers’ data suggested the implants should last at least a decade. “The current implants are no worse than before and ought to be better, based on the clinical and laboratory data, which is the only way you could rationalize approving a device that you have only three or four years of data for.”
(Sybil says: It seems to me that a scientist who approves a product just because it is “no worse than before and ought to be better” doesn’t understand the FDA mandate, which is safety first, and may never have read the Hippocratic Oath, which is “first do no harm.”)
About informed consent:
“But with breast implants, informed consent is much more fuzzy because each doctor has his own perspective on how long they last, making it difficult for patients to realistically calculate the risks and benefits,” Dr. Goldberg said. He has testified as an expert witness for both plaintiffs and defendants in implant litigation cases and teaches a course in which he uses breast implants as a case study of a badly engineered medical device.
This is a terrific article. If I had to make a suggestion about how it could have been stronger, then I would have urged them to use hard numbers to make their point. So here, let me do it for them:
Cosmetic surgery is not covered by insurance. So from the time a woman gets her first set of implants (say, in her 20s) until she’s buried maybe 60 years later, she will have had to pay for more than seven operations out of pocket since implants need to be replaced every seven to ten years. In addition, after implants, she cannot rely on mammograms anymore for breast health; the FDA recommends MRIs every two to three years, which are also not covered by insurance. A decent plastic surgeon charges about $6,000 per breast implant operation, while an MRI costs about $2,000. Over a lifetime, this adds up to about $80,000.
$80,000! This is money NOT spent on a down payment for a house, mortgage payments, piano lessons for the kids, college tuition, not earning interest in a retirement account… And if there are complications (which we know are very likely), the price would soar indeed. So, getting breast implants is not just a “trip to Paris,” as plastic surgery Dr. Linda Huang compared it to in the New York Times article, it could cost a life well-lived.
So here are some things I hope the New York Times will follow-up on in future articles:
1) What proportion of implant recipients actually follow the safety recommendations and actually get those MRI check ups and replace their implants every 10 years or so, as recommended?
2) How many women do not follow the safety recommendations because they can’t afford it? How many women forgo treatment when they experience complications?
3) How many families are being driven to insolvency struggling to pay for treatment for illnesses related to breast implants? How many families are breaking up due to the emotional and fiscal toll?
These days, almost all the cultural cues we get about breast implants – from plastic surgery ads and the 30-minute breast augmentation procedure to Dr. 91210 and Heidi Montag – indicate that they’re harmless fun: Hey, Ladies, they are a breeze to get, they’ll make you feel better about yourself, and everyone’s getting them, so why not join the party? Even news media has for the most part retreated to generating stories about such topics as how to choose between silicone and saline or how to select a plastic surgeon, coverage that assumes perfect safety. Meanwhile, breast implants are responsible for a great deal of suffering, but victims are largely silent because everywhere they turn for help, they’re told that their mysterious symptoms can’t possibly be caused by their implants, or they don’t even look for help because they just can’t afford it. Here at Beauty and the Breast, we’re trying to be a voice for these women, to tell the real story about breast implants, but it’s so very hard to be heard above the din of the cultural party that breast implants have become.
Thank you, New York Times, for adding your considerable voice to ours. When you cover an issue like this, it may not have national security implications like when you published the Pentagon Papers, but you are still speaking truth to power – the power of plastic surgeons and implant manufacturers who are getting rich at the expense of women’s health. In this case, though, you are reaching into the lives of hundreds of thousands of women where you can have a real impact on their health and the well-being of their families.
Sybil..This was a terrific post! The NY Times did a good job on this one! The one line in the article that REALLY TICKS ME…is DR. Jewell comparing the major surgery of breast implants to a haircut or a manicure! GRRRRR
“Women are used to having their hair or nails done on a regular basis to maintain their appearance,” said Dr. Jewell, who has conducted clinical trials for both implant manufacturers and is a consultant for Allergan, the manufacturer behind the ads running in Elle. “Ultimately, breast implants may also be a matter of maintenance.”
Comment by Pam — January 17, 2008 @ 9:27 pm
FDA is a liar breast implants did me harm. I was a very healthy young women who loved to exercise and eat healthy. I became very ill as soon as I got these breast implants. Go to Yahoo Saline Support groups and see all the women who we are trying to help to get better from being harmed from breast augmentations. the silcone and saline breast implants.
We are mad how we were lied too about those deadly things. Some women have lost their lives over these things you so call safe.
Comment by Shelly in Ohio — January 17, 2008 @ 11:36 pm
Thanks so much Sybil . . .
The article was great - as far as it went . . . Grossly overlooked is the fact that there have been no significant studies (after being on the market over 40 years) of the health effects on sick offspring of implanted women. There is a tragedy here that is beyond imagination! . . .
Once a woman becomes symptomatic, the chance that her child will experience rashes, allergies, digestive issues, joint and bone pain increases dramatically… If they were unfortunate enough to inherit specific HLA types, the problems may be far more serious! . . . Deformed extremities, multiple autoimmune problems . . . even death!
Something that troubles me is that most women don’t realize the manufacturer’s warranty covers only REPLACEMENT. If a woman choses to remove them for health reasons, she’s on her own!
Another troubling thing is how 80,000 women will be selected for the next stage required by the FDA . . . I suspect they will be cherry-picked from the women who were lucky enough to stay healthy and keep their implants. . . The others will be dropped from the studies - just as they have been in the past.
There’s more than one problem here! . . . Hello Washington! Are you listening?
Rogene
Moderator of SiliconeKids - A support group for the families of children made sick by silicone devices.
Comment by Rogene — January 17, 2008 @ 11:36 pm
Hi Sybil- I’m the Krista in the article. I just wanted to point out that Natasha DID ask me about my illnesses. We did not go into a great bit of detail about them, but we did talk about them. I had really hoped the article would touch on that aspect, and was disapointed that it didn’t. It made me wonder if after reading the article people wondered why I had both of my implants removed in the same exact year that I had one of them replaced after a rupture.
I’m just glad that even one aspect of the issues with breast implants was discussed. This is one more step in the right direction for us.
~Krista
Comment by Krista — January 18, 2008 @ 10:18 am
The article states: “Your implants may last less than 10 years or more than 10 years, but when you start having problems with them, your health insurance is unlikely to cover the M.R.I. tests or the reoperations,” said Carol Ciancutti-Leyva, the director of a 2007 anti-implant documentary called “Absolutely Safe.” “It can be a very expensive proposition, especially if you are young.”
I believe young people have no idea how much breast implants may cost over the years. My breasts were augmented at age 19, and my (well-qualified, highly recommended, and board-certified) plastic surgeon said that the only reason I would need an additional surgery is if I wanted to “go bigger” or “have silicone gel implants put in”. I happily thought to myself, “Nope, no extra surgeries for me.”
Well, 2 years later my breasts were burning and overly sensitive (among other systemic complications) and I had to have my implants removed. I fought my insurance company for 8 months, and they finally covered the $6,500 it cost to remove my saline implants and put my breasts back to normal. In 2 years, I incurred over $10,000 of breast expenses. You bet augmentation is life-long committment!
I came out on the cheaper side, as the least amount of surgeries you can have is two…one to put them in, and one to take them out. If these teens and 20-somethings knew that they were looking at implant replacement surgery at least every 10 years, and that they would be forking over about $5,000 each time, I think they’d take a step back. I’m glad I’ll never know what it’s like to tell my grandchildren, “Sorry there’s no Christmas this year, Grandma’s 80-year old breasts needed another tune up.”
Comment by Kacey — January 18, 2008 @ 2:48 pm
Thanks to everyone for your responses to my article. Everyone made important additions to my thoughts.
Krista - you were brave to come forward and tell your story. I know you helped a lot of people have greater understanding of breast implant issues. A special thank you to you.
And, above all, Hooray for Natasha Singer who talked about breast implants with a new approach. We, implanted women, already knew what Natasha Singer wrote about but Natasha sent it out to the many who needed to start thinking about implants in another way.
Comment by Sybil — January 18, 2008 @ 9:54 pm
It’s great that this article talks about some of the negatives of breast implants, but it could’ve gone further and mentioned the illness aspect. Mold growing in my so-called “safe” saline implants made me very ill within 3 years of having them implanted. I’ve also had 8 surgeries because of previous problems with silicone implants. Women need to be informed of ALL the risks. Manufacturers, doctors, politicians, and the FDA prefer to pretend implants are safe–the money is just too big.
Comment by Kate — January 19, 2008 @ 6:45 am
Great work ladies!!!I feel you Rogene, What about our offspring and generations to come?My heart bleeds when I think of the children, and the ones way worse off then my daughter…how Im so lucky and grateful!
What I have learned..ALOT, but telling people in the public Im very sick from breast implants that almost killed me.Someone seems to always say I knew a lady like this or my moms friend was very sick from breast implants…..then if Im talking to a oral surgeon, they so dont want to hear it and how Im pretty sure my body will react to a forgein object,that Dr. Kolb told us I had human adjuvent desease.
The sad truth is women are glorified there getting implants,and so many dont look at the downside, or told by the doctor with all these pretty degrees on their wall, these women are clueless and then why am I doing B.A. s all day?So breast implants being approved by the FDA,that means there ok to glorified women or young girl getting the B.A.
Being sick 4 years straight,really weak since 2000, 8 years ago…my daughter affected by my breast implants in 2002 into 2003, the burden, all around burdens, is mind blowing to sit and think back what you have been through over one set of breast implants….and how youre still treated when you tell the doctors and dentist,you almost died from breast implants.youre treated like an alien..because you spoke out.Im hoping to still hear back from Natasha again,and I feel really good I was able to rip off all the groups and names and sites.Together we will make a difference!!!!!
Comment by Kerry silicone2000 — January 19, 2008 @ 8:00 am