January 2012 archive

Jan 07 2012

“French-maid Breast Implants”

I’ve been struggling a bit with the story of PiP and the breast implants, because every time radio presenters say “French-made breast implants”, I hear “French-maid breast implants”.

The BBC has a useful Q&A on the subject here. Essentially the problem is that PiP manufactured breast implants using industrial rather than medical grade silicone, subsequently there have been reports, initially in France, that the rupture rate of these implants is significantly higher than expected. There is no evidence that the implants lead to an increased risk of cancer, given the prevalence of breast cancer it isn’t surprising that some patients with the implants have gone on to develop cancer. The striking thing is that the implants were banned for use in 2010 because they were found to be using industrial grade silicone gel, surely it was at this point that they should have been recalled (i.e. the decision made to remove those already implanted)?

The situation in the food industry is quite different: if a company discovered that one of its suppliers had provided non-food grade ingredients then the product that the company made would be withdrawn from sale pretty much immediately. There would be no waiting around to see if the ingredient was actually hazardous, it would be withdrawn on the grounds that it was out of specification. I’m pretty sure similar applies in the car industry, and the aviation industry. I know this because Mrs S used to work in the food industry; food scares on the morning news always led to an exciting day at work as every retailer sought confirmation that the company she worked for did not use any of the products involved in the scare. Food companies trading legally would have this traceability information.

Healthcare does offer a slightly different scenario, in the sense that carrying out an operation to remove breast implants does carry a risk which means there is a downside to removal, but this is the only relevant consideration: all other things being equal the implants should be removed, by the original installer where possible.

Some people seem to feel that women having breast implants have brought this on themselves, that they shouldn’t be helped on the NHS. Clearly the first port of call for removal is the installer but there are cases in which the installer no longer exists; the NHS is a universal service – if someone has a qualifying medical problem then regardless of how they came by it (excessive eating, drinking, drug taking, climbing, skiing) they are treated free of charge. The same should apply to people who have medical problems arising from surgery outside the NHS – the liability is with the original supplier but sometimes they no longer exist, the patient should not be punished for this.

The Medical and Healthcare Products Regulatory Agency (MHRA) is responsible for regulation in the UK. There is a page on their website about the subject of the PiP breast implants here. Other medical devices, such as replacement joints, appear to be handled differently: alongside the MHRA there is the National Joint Registry, which attempts to register all joint implants, here on the National Joint Registry there is a list of alerts for joints. The MHRA has issued a series of alerts, dating back to March 2010, regarding PiP breast implants (you can see them here), the emphasis has been on establishing the potential toxicity of the filler material. This, presumably, can be done using lab-based testing. The problem seems to be that the rupture rate is relatively unknown, this report in the Telegraph says:

A UK Breast Implant Registry was established in 1993 on the recommendation of the Department of Health to track implant patients’ health, but it closed in 2006 as too few women wished to take part in the scheme.

The final report of the UK Breast Implant Registry is here, and the MHRA confirms that the scheme closed because too few patients would consent to remain in long term follow-up here. This would seem to be the significant factor in this case: there is some follow-up for medical devices but it is voluntary and in the case of breast implants the uptake rate for follow-up was not considered high enough to warrant continuing the process.

It still leaves the question as to why the removal of breast implants made from out of specification materials is not assumed, except for considerations of the safety of the removal operation.

Jan 04 2012

Book Review: The First American by H.W. Brands

first_americanBenjamin Franklin (1706-1790) is someone who has crossed the paths of a number of protagonists in books I have read on the history of science, including Antoine  Lavoiser, Joseph Banks and the Lunar Society. I thought I should read something on the man himself: “The First American: The Life and Times of Benjamin Franklin” by H.W. Brands.

Franklin trained as a printer, as an apprentice to his brother. This was a route into learning since he got to read a lot, interacted with learned men and also started writing, when his brother launched a newspaper in their hometown of Boston – one of the early campaigns of this newspaper was against vaccination for smallpox. In the later years of his life he set up a printing press at his residence at the edge of Paris. Franklin ran away to Philadelphia before his apprenticeship finished, making his first trip to England to learn more of his trade with the (moral if not financial) support of the governor of Pennsylvania. This is another example, like Edmond Halley, of rather precocious responsibility which was not so unusual at the time. It turns out the publication of almanacs was lucrative, as was his printing work for the Pennsylvania Assembly. By the 1750s, only in his forties, he was able to step back from his business and carry on earning a good income from it. His trade as a printer seems to me important in honing his writing skills and getting his opinions out in the public domain.

I picked upon Benjamin Franklin primarily for his work as a “scientist”. The first substantial mentions of science in this book come around 1743, it is at this point he founds the American Philosophical Society and does work on a more efficient stove (which he refuses to patent), although in 1726 he is found making observations of a lunar eclipse on his return trip from England. This suggests a scientific turn of mind from a relatively young age. A few years later he is doing original and well-regarded work on electricity, as well as recommending the use of pointy lightning conductors (of great practical importance). He did some work relating a little to my own field: the spreading of oil and water as well as evaporative cooling, the Gulf Stream and some earlier thoughts on meteorology (this seems to strike a cord with some later proposals by Erasmus Darwin).

When Franklin was born Pennsylvania was in the hands of the Penn family, known as the proprietors – other states were controlled directly by the Crown via Royal governors. For much of his life Franklin considered himself to be British but by the end, the United States of America had become a newly minted nation with Franklin a pivotal figure in its creation. I suspect the causes of the War of Independence are the subject of many books. The battle cry of “no taxation without representation” has taken popular hold as a motivation, although at the time the British living in Britain were taxed with not very much representation, this taxation cause is certainly the theme that Brands follows. Also relevant was colonial support for the British in battles against the French, for which they felt little gratitude and that the British gave up in diplomacy much of that which they had paid for in blood. Ineptness on the part of the British political establishment and George III also plays a large part. Franklin’s part in the War of Independence is played politically in London in the run-up to the war, in France during the war – to garner their support, and finally in Philadelphia where he is heavily involved in the creation of the United States of America.

Throughout his life Franklin was a civic activist, a community politician, setting up the Junto (something of the character of the Lunar Society) and the American Philosophical Society (more like the Royal Society). He also founded fire brigades, a Library Company, an academy and a militia. In a sense the United States of America were the culmination of this civic activity.

For much of the last 25 or so years of his life, from 1757,  Franklin was resident in either London or Paris. In London as a representative of the Pennsylvania assembly to the British state, and in Paris similar when their help was sought in the war against the British. He appears to have fitted well into high society, and been exceptionally highly regarded in both countries. No doubt this is in part due to the formal position he held but prior to his arrival he was known in both cities via his interactions with learned societies (the Royal Society and the Académie des Sciences). He strongly considered staying the rest of his life in London, which is odd since his wife was unwilling to join him there.

In the same way that Poirier’s biography of Lavoisier introduced me to the French Revolution, this book on Franklin has introduced me to the American War of Independence. It’s like sneaking vegetables into a child by hiding them in something they like!

Footnotes

My Evernotes on this book can be found here.