January 8th, 2012


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.