00:52:00

Hosts: Anna Reser, Leila McNeill, and Rebecca Ortenberg

Producer: Leila McNeill

Music: Careful! by Zombie Dandies

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For this episode, the hosts talk about the intersection of gender and health in the court system through the history of breast implants. Starting with the first implant surgery to the current debates about the safety of implants, the hosts explore what counts as “scientific evidence” in the courtroom and our own cultural assumptions about breast implants and the women who choose to get them.

Show Notes

Women need better information on breast implants, panel says by Laurie McGinley

Women who say they were sickened by breast implants demand FDA action: ‘I was not warned.’ by Laurie McGinley

Anaplastic Large Cell Lymphoma (ALCL) In Women with Breast Implants: Preliminary FDA Findings and Analyses from the Center for Devices and Radiological Health, FDA

Doctors, Lawyers and Silicone: A special report.; Implant Lawsuits Create A Medical Rush to Cash In by Gina Kolata and Barry Meier

SILASTIC demonstration mammary sizer implant seamless design 350 CC manufactured by Dow Corning Corporation via Science History Institute

America Is Too Glib About Breast Implants by Amanda Mull

Further Reading

Timeline: A short history of breast implants

Silicone Breast Implant Litigation by Kristin E. Schleiter

The Bizarre and Painful History of Breast Implants by Erin Kelly

Transcript

Transcription by Rev.com

Rebecca: Welcome to Episode 18 of the Lady Science Podcast. This podcast is a monthly deep dive on topics centered on women and gender in the history and popular culture of science. With you every month are the editors of Lady Science magazine.

Anna: I'm Anna Reser, co-founder and co-editor-in-chief of Lady Science. I'm a writer, editor, and Ph.D. student studying 20th century American culture and the history of the American Space Program in the 1960s.

Leila: And I'm Leila McNeill, the other founder and editor-in-chief of Lady Science. I'm a historian of science and freelance writer with words in various places on the internet. I'm currently a regular writer on women in the history of science at SmithsonianMag.com.

Rebecca: And I'm Rebecca Ortenberg, Lady Science's managing editor. When I'm not working with the Lady Science team, I can be found writing about museums and public history around the internet and managing social media for Science History Institute in Philadelphia.

Leila: So before we dive into the episode, I wanted to say that we're currently running a special series on the website about women, health, and the law. We have so many different kinds of perspectives that examine how gender and medicine intersect with our legal system. And we're covering everything from breast density to euthanasia. And we're running this series the entire month of April, so be sure you check it out at LadyScience.com/blog.

Rebecca: So with that in mind, that sort of brought us to our topic today. But when you usually think about issues related to women, health, and the law, you probably don't think about breast implants. But that's what we're going to be tackling, and it's a really fascinating story.

Rebecca: For decades now, researchers, plastic surgeons, the FDA, and women themselves who have received breast implants have been investigating their safety. And this is a very complicated history, and it's wrapped up in debates about what counts as evidence in the courtroom and our cultural assumptions about breast implants and the women who choose to get them.

Rebecca: So just last month, the FDA began investigating reports that showed a possible link between a particular type of textured implant and a rare form of cancer called Anaplastic large cell lymphoma. This is a form of lymphoma that attacks the immune system and originates in scar tissue that surrounds the implants, and doctors usually treat it by taking the implants out. The FDA has now identified 457 cases and nine deaths in the U.S. linked to this form of cancer.

Rebecca: And this isn't actually the first time the FDA has looked into the link between silicone implants and this particular type of cancer. In 2011, they released a safety communication that explained this possible link and laid out actions that they would take to investigate. And it also recommended, among other things, that surgeons report all confirmed cases of the cancer in women with breast implants.

Leila: Yeah. And so just because we have evidence that implants can lead to this rare form of cancer doesn't automatically mean that the implants will be removed from the market or that women with these implants should get them removed to prevent the cancer. First of all, just because a woman has the implants does not mean that she will automatically develop cancer.

Leila: The questions kind of come up, "Do we just add this as a checklist of risks and side effects, or does this warrant more heavy-handed regulation?" But to even get to answering those questions, the FDA has to come to consensus that there is a problem to begin with and this is where things start to get messy and complicated.

Leila: According to the Washington Post, the FDA regulator said in documents that they released before their meeting to discuss these findings that it is impossible for them to determine the exact frequency of the cancer because, "The U.S. does not track the total number of implants on the market. Estimates of the frequency of the disease range from 1 in 3,000 women to 1 in 30,000 women." This lack of data about the implants themselves was a problem in 2011 and it's a problem now. The failure to even track the number of implants on the market, which here I will remind everyone that these are medical implants that require an invasive surgery. This isn't just a simple Botox injection. This failure is indicative of a real carelessness that has pervaded the history of breast implants in this country, and that's kind of what we're gonna talk about today.

Leila: Let's go back and take a look at this story to see how we got here, how not much has changed, and how researchers and the FDA in particular approach the safety of breast implants.

Anna: Breast implants have been on the market since the 1960s. To me, Jean Lindsey was the first woman to receive a silicone implant from doctors Thomas Cronin and Frank Gerow in 1962. The implants themselves were manufactured by the Dow Corning Company. Before this surgeons had been performing breast augmentation but using different materials. Things like wool and sponges, and in some cases glass balls, which sounds really heavy.

Leila: And fragile and delicate.

Anna: Yes.

Rebecca: A bad idea on so many levels.

Anna: The first use of silicone was in Japan during the Second World War. Japanese women injected non-medical grade silicone into their breasts to make themselves more appealing to American men by conforming to sort of white Western ideals of beauty. All these methods obviously were incredibly dangerous and side effects ranged from scarring and skin necrosis to death. But Timmie Jean Lindsey, however, didn't suffer these side effects. Her surgery was considered a success. It wasn't until 1976 that breast implants came under the purview of the FDA when they rolled out the Medical Devices Amendment and took over regulation of medical apparatus.

Anna: Since breast implants had been on the market for over a decade, they were grandfathered in under the amendment, which basically meant that the implants were assumed to be safe because they were already in use and the manufacturers didn't have to prove that the implants, to prove their safety and efficacy like they would if it was a new product that was coming in to the market after the amendment.

Leila: Yeah, and I guess here we can say that before Cronin and Gerow performed the surgery on Timmie Jean Lindsey they performed the surgery on a dog to test to see if it would work. That's the very rigorous testing that this underwent before they started just putting it in women, so very rigorous, controlled studies.

Rebecca: The bit about silicone becoming popular among Japanese women after World War II is just like ... I feel like, and I'm sure people have, I feel like you could write a whole thing about the power of the U.S. in the post-World War II world and Western beauty standards and all of that, just baked into that piece of the story.

Rebecca: But to move the story forward, in 1977, so one year after breast implants came under the purview of the FDA, the very first lawsuit related to breast implants was filed. I like that it took just a year. The woman who filed the suit, her implants ruptured and she won a $170,000 settlement. Then in 1982, so about five years later, an Australian report found connective tissue disease in three women with silicone implants. That same year in San Francisco, a multi-million dollar lawsuit was filed claiming that silicone implants were causing connective tissue diseases.

Rebecca: At this point things kind of snowball and many people begin filing lawsuits that claim the same connection. They also start claiming connections between implants and autoimmune conditions like rheumatoid arthritis. At that point the FDA put breast implants into the Class 3 category for medical devices. This is a risk-based class that basically means that there is a higher risk to a patient who receives the device.

Rebecca: Then in the '90s when the really big lawsuits happened, in 1991, Brenda Toole won a $5.4 million settlement against Dow Corning based on the claim that her breast implants increased her risk of developing cancer and autoimmune disease. Later that same year, another woman, Mariann Hopkins received a $7.3 million settlement by linking her connective tissue disease to her ruptured silicone breast implants.

Rebecca: In 1992, the FDA issued a moratorium on these implants because manufacturers had clearly not proved that they were safe, but in 2006 the FDA lifted the ban. Here we are today with the silicone implants under investigation again.

Leila: Yes, and in that time when the silicone implants were banned, saline mostly took over. Saline is still used today as well as the silicone implants. I think it's the Mariann Hopkins lawsuit, the $7.3 million one that is the largest class action lawsuit settlement ever. I think. I think that still holds true. I'm not entirely sure. That one was a doozy. And Dow Corning, I think, eventually also had to file bankruptcy after this whole mess.

Rebecca: Oh wow.

Rebecca: Also, just to throw in here, 'cause I think it's kind of cool, at my other job, the Science History Institute, we have one of those Dow ... I mean not exactly one of these, but we have a Dow breast implant from the 1970s or 1980s in our collection. It's like a sample one, and it's just like in a box. You can see-

Leila: And it's just one?

Rebecca: There's only ... I don't know where they're stored. I'm not our collections manager. Only one of them has been digitized, and so I've only seen a picture of what I assume is one of them. But it's kind of weird because it's just sitting there in a box and it just looks like a weird blob. But it's interesting. If you want to see a picture of one of those, you can look at our collection.

Leila: We'll put that one in the show notes. The way that this all played out in the courts is actually pretty complicated. It's not so straightforward as, "These women won their lawsuit, so clearly we're done and we have moved on." It's actually really complicated and so we'll do our best in unpacking this.

Leila: With the slew of lawsuits, which by 1995 had amounted to $4.25 billion. That was billion dollars. Many women with silicone implants were worried about their health, and in step exploitative doctors and attorneys to cash in.

Leila: In 1995 the New York Times reported that some doctors were cashing in on women's concerns about their health and they point out one doctor who charged $6,000 for an examination and subsequent tests. The Times also found that at least two doctors agreed to let women defer part of their payments until after they won a settlement. Others in the medical community were quite critical of these doctors for obviously good reason, for preying on women's fears and performing unnecessary tests on women in exchange for large sums of money.

Leila: The attorneys who worked these cases sent referrals to these doctors and there were other reports that showed that some doctors who served as expert witnesses in these cases were paid for their testimony. The attorneys also orchestrated media attention and they hired PR firms to give high-profile interviews in the hope of swaying public opinion about breast implants and by high-profile, it's like 60 Minutes, which I guess has kind of dwindled in popularity now, but in the early '90s, 60 Minutes was the jam for getting your news.

Leila: Without much hard evidence, exploitative attorneys in doctors were able to wield a wild amount of control over the cases. This has really muddied the waters in the sense that it's been hard to separate the carefully stoked fear and crafted narratives from the facts.

Anna: This is great doctoring behavior, very good observation of the Hippocratic oath and all of that. Good job, doctors.

Leila: Yup, yup, yup. Yeah I think there was one, the one who was charging the $6,000 in the New York Times piece, when asking about being accused of performing unnecessary exams on the women, he was like, "Look, they're not unnecessary. I'm just trying to understand what's going on here. I'm just trying to learn about the silicone implant problem and enlighten the world and help these women," for $6,000 each.

Anna: Well and of course no doctor has ever used the justification that he was just trying to help or do research or understand the world to do anything bad. I mean, that's obviously never happened. So yeah.

Rebecca: And it's one of these things where, and I feel like we'll get into this even more, but there are so many instances when women are ... refuse tests that they should get, or told that they're being silly or that a problem is all in their head with doctors dismissing their concerns that then the idea that a doctor can exploitatively tap into that need to have someone who will listen to you and take you seriously, but in this model this is just meant to take all your money and make them look cool because they get to be an expert witness in a class action suit about breast implants or whatever. It's one of the really infuriating things about the story.

Anna: If all of this questionable doctor ethics wasn't enough to add confusion to the debates about implant safety, the lack of solid studies at the time really made it even more difficult to sort out. When women started bringing lawsuits about breast implants, there were virtually no serious studies that showed implant safety or danger. All they had was the individual women's medical history and experiences. This is in part because the implants were grandfathered into the amendment and they didn't have to do any studies.

Anna: In 1992 is when the first serious studies started to be published. These focused on the claim that silicone implants caused breast cancer. None of these studies found evidence that implants resulted in a higher risk for breast cancer, and after this, lawsuits focused less and less on this claim.

Anna: Like we said earlier, the new findings under the review for the FDA that we were talking about, they're not for breast cancer, they're for a rare form of lymphoma. Just to be really clear about that.

Anna: The claims that implants cause autoimmune disorders and connective tissue disorders were even harder to pin down. In the 1980s, case reports on women with implants and connective tissue disease started to popup and these case reports continue to appear today.

Anna: In the mid to late '90s, case controlled studies looked at links to connective tissue disease all concluded that silicone implants didn't result in an increase in connective tissue disease. The latest study was conducted by researchers at the University of Texas MD Anderson Cancer Center in 2018. They looked at a 10-year study conducted by implant makers Allergan and Mentor, but at least half of the women dropped out of that study. So what data they did manage to gather is what MD Anderson looked at. Already what they're working with is kind of incomplete.

Anna: They found that women with silicone implants had greater risk of Sjorgren syndrome, which is an immune system order, scleroderma, connective tissue disease, and melanoma, which is skin cancer. Since the study was incomplete, the data was very limited. An FDA regulator said that they disagreed with MD Anderson's conclusion. Everything is very muddled still.

Anna: Despite thousands of women who still attribute their various health problems to their implants, the FDA and now decades of research insists that they are mostly safe when the procedure is performed correctly and the implants are maintained afterward.

Rebecca: So there have been a few retrospectives written more recently that have looked back at these big lawsuits of the 1980s. One thing that comes up and not a lot of scientific evidence was presented in these suits. The scientists who did offer expert testimony were usually bought and paid for. The suits were really settled on anecdotal evidence from women and just kind of general public opinion, which is kind of problematic. It's not the most scientific rigorous way to figure out if something is a problem.

Rebecca: Like we were just saying, there also were just not a lot of scientific studies done about breast implants at the time. Those came later after all of the lawsuits. In a case like that, what should count as evidence?

Leila: I mean that's a really hard question. Anyone wanna take that one?

Anna: I think it's interesting and goes a long with a lot of the stuff that we talk about in the podcast and write about in the magazine, but a lot of the evidence is anecdotal evidence and it's testimony from women and that's automatically going to be suspect. I think obviously this isn't true for everyone in all places, but there is a tendency to, I think, stereotype women who get breast implants in ways that would make their testimony appear even less reliable than it would normally, that they're frivolous or shallow or self-observed-

Leila: Cosmetic.

Anna: Yeah, and that having implants is like an elective cosmetic surgery, and that maybe they're just gold digging for money. Things like that. I think there are cultural things that impact how we think about what counts as evidence in cases like this.

Rebecca: The other thing that comes to mind for me that we talk about also, I think, regularly on the podcast and in the magazine is just the fact that science and medicine hasn't spent a lot of time in the grand scheme of things thinking about women's bodies. There's a lot of things we don't have good medical evidence for or about because for a long time it was just like, "Women's bodies are weird. I don't know. Let's not think about them." I feel like this kind of the fact that there wasn't a lot of knowledge about breast implants when all these lawsuits happened comes in part from just the general idea that it's like it's not the kind of thing that doctors think of studying, and so when stuff goes wrong with it everyone's like, "I don't know."

Leila: Yeah, I think that's exactly right. The studies that came more after the fact, after women starting coming forward with issues, they were creating studies based on that. They were looking at breast cancer, not this other form of cancer, which takes a long time from what I can tell, to actually develop. It's a slow-developing cancer. If they were looking at cancer, which it seems like they were focused specifically on breast cancer, not any other kinds of cancer, who are they enrolling in their studies? Is it someone who just had them, or is it someone who has had them for 10 years and has maybe now developed the cancer?

Leila: It also depends on what questions they're asking, and the questions that they're asking are based on all of these things after the fact. That's not gonna give you a holistic, I don't like saying holistic in the sense that evokes like, "Holistic medicine," 'cause that's certainly not what I'm advocating for. It doesn't really give ... there's no holistic study of a woman's body and how they interact with these implants.

Anna: This could have been done if the FDA didn't have these policies in place that basically protect companies from having to spend money doing studies to vet things that they've been marketing when they probably shouldn't have been in the first place. However long the FDA takes to catch up with whatever new thing is on the market, if they saw these policies in place that grandfather in these products and they don't have to pay to have these studies done, then you get the situation that Leila's describing where the studies don't start from a holistic place considering everything all at once, they start from, "Well, what are the lawsuits about?" Or they start from assumptions like, "If you're gonna get cancer from it, it's gonna be breast cancer."

Leila: Right. Exactly. Because your breasts are just completely separated from the rest of your body.

Anna: Yeah.

Leila: The thing is the one that they're looking at now is a form of lymphoma.

Anna: Right.

Rebecca: I do think that their lymph nodes are there.

Leila: It certainly, the way that the studies have been done since then have not been conducted well. The company that MD Anderson, they took their data and looked at it, the one where they were looking at the 10-year period, but half the women dropped out - apparently the FDA has fined them monies for not following through with their rigorous study.

Leila: That's ... I don't know, it's something. I hate when we get bread crumbs we're like, "Yay."

Rebecca: It kind of makes me think, I don't know how 100% true this is, but I feel like I've heard kind of in the grand scheme of things in the U.S. ... or especially in Europe, a company has to prove that something is safe, whereas in the U.S., and company just people have to prove that it causes harm, like where the benefit of the doubt falls in terms of a new product out in the world. This kind of feels like that sort of thing too a little bit, where it's a consumer product, it's fine until it has been proven otherwise, not, "Hey, this is a thing that goes into people's bodies. It's a medical device that needs to be proven to be safe before ..."

Leila: That is supposed to be part of what the FDA does. That was part of what happened after the thalidomide stuff, that was one of the things that they added that you had to show safety and efficacy. I think that is a good distinction that you made, Rebecca, because there's been other countries that have banned these textured silicone implants because of the link to that specific form of cancer. I think the way that we regulate things compared to other countries with different healthcare systems and different cultural ideas and beliefs about regulation approach this differently.

Anna: Yeah, I think there's also probably something to be said about the difficulty in portraying breast implants as medical devices in American culture, in particular, and that that contributes to them not being taken very seriously, because we all agree that a pacemaker or a stent or something like that is a medical device, but because it's "cosmetic surgery" and because it's supposedly frivolous, I think we tend not to think of breast implants as medical devices even though they are and they should fall under the same regulation.

Anna: Another thing about that is we tend, I think, to forget that not all people that get breast implants are women, and not all people who get breast implants get them for aesthetic reasons. Some people get them to treat their gender dysphoria. Some people get them after they've had mastectomies. There are a lot of reasons that people get breast implants and they are not all the pop cultural idea we have of why a woman would want to have larger breasts.

Leila: That gets into this last thing that I wanted to bring up, that with all the issues with the courts and the lawsuits aside, I think the problem with breast implants goes much deeper. That kind of gets to these cultural issues.

Leila: Last month Amanda Mull wrote a great piece in The Atlantic about how America is too glib about breast implants, and that they are seen as more of a joke than a serious medical procedure. With this latest round of FDA investigations, she writes, "No matter how the FDA moves forward, at least part of the problem faced by patients is the glib culture that can downplay the procedure's seriousness." So she points out that breast augmentation is fundamentally different than a lot of other types of cosmetic surgery, which involve taking something out, so like liposuction.

Leila: Breast augmentation comes with the same issues involving an operation and with the limitations of the device, which we're meaning the implants here. Many women will have to have additional medical work done on their breasts to maintain them in the long term, but she argues that the casualness with which we as a culture treat "boob jobs" downplays the importance of maintaining them properly.

Leila: She also points out that variations in state laws has opened the door to surgeons who are not board certified to perform these operations. These surgeons often do so in assembly-like fashion and in low-cost settings. So whether you agree with the FDA and the many researchers that believe implants to be safe, you can't really deny that implants and the people who get them, both historically and presently, and not taken seriously enough. If anything our cultural attitude about breast implants really need to be interrogated and changed.

Leila: I think that we see people who need breast implants for reconstruction after a mastectomy versus someone who's getting one for ... you know, us as women who wants them for cosmetic reasons, and then a trans person who wants them to treat their gender dysphoria, that we see those reasons as being frivolous or not serious enough. One, I mean that's of course shitty, but also it doesn't matter. This person, whoever they are is going through an operation and they should be treated the same way that anybody else who's going in for a procedure or operation, no matter what you think of their reason for having it is.

Anna: Yeah. I think there's also, I wanna be careful here because I don't mean to cause any harm by saying this. I think there's a tendency to romanticize breast implants for certain people. So if you're getting breast implants as part of your reconstruction after a mastectomy, there is a kind of like, what I find personally as a person who has breasts to be a really kind of like gross, fetishizing, mushy culture around breast cancer, that romanticizes people who had breast cancer and turns them into these inspiring stories of overcoming. We receive all these signals about how we should support people who need this reconstruction and that them getting their breasts back is a really important part of their healing process and all of that stuff. I think that that is all true, but the way that that is portrayed, sort of cultural sense, has effects on the way that we treat women who get breast implants for other reasons, or the way that we treat people who aren't women who get them for other reasons, whatever the case may be.

Anna: I think that there is definitely a breast cancer industrial complex in this country-

Rebecca: Oh my God, that's true. Yes.

Anna: The Susan G. Komen thing is ridiculous. Don't get me started on the various breast cancer awareness things that are really gross. I think that can be part of the conversation too, is that we seem to be very good in American culture about separating out when and where it is morally acceptable to be someone with breasts.

Leila: Yeah. Right, and I think that bringing in kind of the fetishizing of women who get reconstruction augmentation, that is a completely different conversation and the rhetoric around that is completely different. That is all about empowerment and they kind of co-oped feminist language in a way to say, "Well this is about loving your body, getting comfortable in your body again," that type of thing. Whereas a person who is not getting breast augmentation for a completely different reason, that it's to make themselves more attractive to men or that they kind of lose the agency of behind why they're opting to have this operation.

Anna: And that conversation intersects with conversations about disability and about ableism, and about how we fetishize people with impairments, people who are sick, people who have disabilities. It has really far reaching sort of tendrils into other aspects of, I think of American culture is mostly what we're speaking about here. That being sick is inspirational somehow, and that you get to transcend norms about bodies because you've been sick, and that we can reframe conversations about people's bodies to make them inspiring by, like you said, co-opting this rhetoric about feeling comfortable in your own body and being empowered, but if you don't have what we consider this moral purity of being sick as a motivation for wanting to change your body, then you're frivolous, then you're shallow. You're immoral. That kind of thing.

Rebecca: Yeah.

Leila: Yeah.

Rebecca: It feels like it's one of these things where I sort of get the impression that a lot of advocates for people with breast cancer, even like the non-icky ones, sort of put a lot of work as they should into making breast reconstruction surgery part of the conversation, and I feel like ... there have been stories in TV shows where they talk about women having breast cancer and then making those choices and the pros and cons and all of that complexity. It's good that more people have been able to center that, but it happened in this way where folks centering that some kind of felt the need to say, "We're different than other people getting breast implants," so some folks couldn't just have a conversation about how women have a right to do with their bodies what they want, and that maybe breast implants should be morally neutral for everyone, but instead had to be, "No, it's special for this group of people over here because they're different from these people over there."

Anna: That's because everybody is sort of laboring under the same kind of patriarchal umbrella of ideology about breasts and what they mean, and that the reason that breast cancer advocates who are talking about the need for reconstruction to be part of that conversation and to be an option for women who had mastectomies, which I think is really good, but the reason that they feel they need to set themselves against this is because we have this idea that, "You don't get breast implants unless you're a bimbo."

Anna: That is the overarching cultural conversation about this, and it has to do with the fact that American culture can't conceive of breasts as anything other than a sexualized ...

Leila: What men want.

Anna: Yeah, what men want, and what men like and how attractive they are to men. That colors all the conversations about this.

Leila: Yeah, and it's like the breast cancer advocates for reconstruction are trying to separate themselves or at least break away from ... there's an awareness that that's there. That that patriarchal, you know, beliefs about breasts is there. They understand that. They know it's there. They're aware of it, which is why they have to change rhetoric. They have to change the conversation for them even though they're leaving all of these other people behind that need it for different reasons.

Leila: Again, the fact that they coop feminist language to do that, I have a lot of problems with that. I mean, I've had a lot of problems with the Susan G. Komen brand of breast cancer advocate for a really long time. I mean, having multiple people in my family with breast cancer, I can't stand it. I can't stand the language of survivor and losing a battle. I can't stand ... I think that that type of rhetoric is absolutely terrible. We should never talk about an illness that way. Or in the people who have that illness.

Anna: I mean, then there's ... you can cut this out if you want since I'm just talking nonstop about baseball, but the Cubs breast cancer awareness thing-

Leila: I did not think that you were gonna go to baseball after that.

Anna: It's not about baseball. It's about bad media, you know. Whatever you put there. Their a breast cancer awareness night, like their campaign is Save Second Base.

Leila: So it's like serious, oh my God, I hate everything.

Anna: It's really bad, but it's kind of the same thing with ... part of the reason that this story about breast implants that we've been talking about today anyway, is so complicated, and part of the reason that the science is so muddled and that the legal cases are so involved is this larger ideology that we've been talking about, this patriarchal conception of the body that sexualizes breasts and sort of sets out limits for when it's acceptable to have them and for whom and in what certain context, and it has to do with what men are interested in.

Anna: I think this is a really interesting conversation to have about this sort of object in particular, because it touches on so many of the things that we talk about in Lady Science all the time, about the way that the intersection of science and culture is a very messy place, and that the things that we think about as objective, like maybe it seems obvious or given that you should investigate whether breast implants cause breast cancer, but it's not. That comes from somewhere. That comes from a larger understanding that we have about how women's bodies work, or a misunderstanding more often than not.

Leila: Yeah, exactly.

Anna: I think it's a really sort of tidy entry point into these conversations, and something that people have strong opinions about, and something that people probably have experience with, at least in a popular culture sense. I'm saying good choice of discussion topic. Nice work.

Leila: Yeah, and I wanna say when I was diving into this research, I mean, it's just like wading through a bunch of stuff to try and figure out where the story is because it goes in so many different directions. I didn't even get to the nugget about the exploitative doctors until after I had already read all this other stuff about the research in the lack of studies and all that stuff, and I was like, "Oh, my God, this just keeps getting more and more bizarre."

Leila: Of course a story that starts with putting breast implants in a dog is going to end up in this completely elaborate themed monster of a history, but after going through all of this stuff and reading all of the stuff that I did, I mean, I still don't know. I can't come down firmly and say I'm gonna side with the FDA and the researchers, or I'm gonna side with the health concerns. I don't know because of all ... I knew even, I went into this thinking the FDA and there all just a bunch of assholes, which they are. I will say. They certainly are. Once I actually got into it, I kept going back and forth because the story kept going back and forth.

Anna: As a 20th century American historian, anytime I see Dow anywhere I'm like, "What did they do this time?"

Rebecca: Yeah, right.

Anna: It reminds me, Leila, of our attempt to investigate what constitutes a medical device at various points in history.

Leila: Oh, God.

Anna: We were doing some research about various forms of contraception and so we were trying to determine what does the FDA consider a medical device in this time period, and in this time period? Turns out that is impossible because we asked the FDA historian and she didn't know either.

Rebecca: Figures.

Leila: Yeah, 'cause the thing that we were running up against was the issue of medical device versus a cosmetic device, and that's almost the same issue culturally at least that we've got going on with the breast implants.

Rebecca: Yeah, and it goes to show that even if the FDA decides, "Yes, this is a medical device," as they should, that doesn't exist separate from culture and separate from then how ... does the surgeon think of it as a medical device as an individual human being, or does he think of it as a cosmetic device? If he doesn't think of it as a medical device, then the FDA can lay out all the regulations they want and the doctor is still gonna have this social-cultural idea that this is not medical in the same way that a pacemaker surgery would be.

Leila: Yeah, exactly.

Anna: I like also this notion that the FDA had to tell doctors that they should keep records of whether or not their implant patients get cancer. I think that's pretty telling.

Leila: Yeah. The women who were talking to the FDA giving their testimony back in March, a lot of them were saying, "We were not warned that this could be a side effect." 'Cause they give the normal side effects like rupture, scarring around the implant area, stuff like that, but not being warned about the cancer, not being warned about the autoimmune and connective tissue diseases. Again, because there's no consensus about whether that's even a thing to tell people about. It's just a failure on multiple levels, like from the very large FDA failure all the way down to the individual interaction with your doctor failure.

Rebecca: It's you know-

Anna: Oh, go ahead, Rebecca.

Rebecca: I was just gonna say, it's one of those things where it's like in some ways it would be more satisfying if you could be just like, "Well, there was a cover up." Or, "Well, there was ... well, the FDA's incompetent," or, "Well, Dow is terrible." While those things are a little bit true, it's like the real problem is really this problem of well, nobody bothered.

Rebecca: That is just in some ways more infuriating because it's just like everyone was like, "But they're boobs. Whatever."

Leila: Well and that's one of the things Amanda Mull talks about in her piece is that they sell breast augmentations as boob jobs, which I think, I'm like, just the term "boob job" really is what trivializes breast augmentation and reconstruction. I've tried to 100% stop using that. One of the things that she talks about is how they sell these things like a product, like there's advertisements for it, like you're buying some product at the grocery store. It is advertised in the same way, and it's often punched up with sexist jokes. That is an enormous problem, not only that the people who get these surgeries internalize the casualness that those advertisements and jokes are giving to them, so they are less likely to maintain their implants.

Anna: I was gonna say also that I don't know about you, but I remember watching just like a lot of reality TV about cosmetic surgery in general.

Leila: Oh yes.

Anna: But about breast implants too. There's a chunk of my memory that's full of images from reality TV about this. There was a period when I was growing up where ... I'm just spit-balling here, but I'm assuming it coincided with after these big lawsuits in the '90s and they're making reality TV about people who got breast implants. It takes up a lot of space in my young imagination of watching reality TV about the journey to get to be able to afford them, and then to go in for the consultation.

Anna: I feel like we are sort of culturally saturated with these ideas of what the experience is like.

Leila: I'm visualizing all of it, like how they put the marker on the face or around the boobs and on the chest. I am visualizing everything.

Anna: Sitting in the paper gown that's open in the front talking to the surgeon.

Leila: Yeah.

Anna: That episode of Sex and the City when Samantha goes in to get her consultation. That's when she finds out she has breast cancer. There's a lot of popular media about that. I think you're right that that combined with the way that it's advertised is like ... it's advertised as a cosmetic procedure in the same way that other things like that are.

Anna: This is not strictly related, but I did want to tell you that a billboard for vaginal tightening has appeared like two blocks from my house downtown and it says, "Vaginal tightening now." It has a phone number and it has a lady on it.

Leila: This is like the 2019 version of those old Lysol commercials where women were douching with Lysol to make their vaginas be more attractive to their husbands. Those advertisements where it's like, "Don't let the smell put him off."

Anna: Yeah, there's been a lot of coverage lately about labioplasty being a trendy procedure to have done. I think the conversation about cosmetic surgery and about particularly procedures that women have done is not going anywhere apparently.

Leila: No, it's really not. I think you're right. Well, I guess that's a good place to wrap up.

Rebecca: We're still stuck.

Leila: Yeah, we're still stuck, which is why we have this podcast. So if you liked our episode today ...

Rebecca: Well done.

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