Tag Archives: FDA

Women’s Health: A Red-Flag Warning

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Seattle Post-Intelligencer: January 12, 2007

We’ve never had much faith in the FDA, but its approval of silicone gel-filled breast implants marks an all-time low for the agency.

Restricted since 1992, the implants were deemed unsafe because of the health risks associated with them, such as cancer. The FDA currently recommends that only women over the age of 22 get the implants. It also asks the makers of the implants (which can rupture during a mammogram), Allergan Corp. and Mentor Corp., to carry out a 10-year, 80,000-patient study in order to “fully answer important questions” regarding the products safety. […]

We spoke to two experts on the matter: Diana Zuckerman, president of the National Research Center for Health Research at the University of Pennsylvania Center for Bioethics, and Susan Wood, a research professor at George Washington University’s School of Public Health. The two scientists want you to know a few things:

 Post-approval studies are common, but the sheer scope of this one should be a red flag. Also, neither the age of breast-implant recipients nor the collection of data by the two companies can be enforced.

 Although you can pay for the implants in installments, you can’t do so for their removal — and they will need to be removed or replaced. Health insurance seldom covers those additional surgeries.

 You’ll need to get pricey MRIs regularly. And no, your insurance probably won’t cover them.

 By no means should you take the FDA’s approval of the implants to mean that they’re safe. For example, their effect on breast milk, says Zuckerman, has “never, ever, ever been tested” by the FDA. […]

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Silicone: Now a Solid ‘Maybe’

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Melissa Healy, The Los Angeles Times: November 27, 2006.

The days before Thanksgiving are typically quiet in the offices of plastic surgeons. But a long-awaited decision to approve silicone breast implants for women older than 22 prompted a flurry of excited calls and inquiries last week from prospective patients. […]

The agency’s decision “does create a whole host of questions” for women considering silicone breast augmentation and for the doctors who perform those procedures, said Dr. Walter Erhardt, chairman of the American Society of Plastic Surgeons’ public education committee. […]

Cleared but questioned

The FDA’s approval — after 14 years of study — had been expected to end the controversy around silicone gel implants.

The devices were pulled from the general marketplace in 1992 amid concerns that they could rupture and endanger women, possibly contributing to autoimmune diseases. Although a link to health problems was never proved, long-term safety has remained an issue. In the meantime, the implants have remained available to cancer survivors and a wide range of women who agreed to enroll in studies of the implants’ safety.

But the new recommendations present patients and their plastic and aesthetic surgeons with additional uncertainties: Who will pay for the recommended MRI scans? What danger does the FDA foresee if patients, as expected, fail to get them? Does the FDA consider that a ruptured implant device — even one that presents no discomfort or proven danger to the patient — must necessarily be surgically removed and replaced? If so, whose financial responsibility would that be?

“Do you think [insurance companies] are going to say, ‘No problem, we want what’s best for the patient?’ ” asks plastic surgeon Marcel Daniels of Long Beach. “No. A lot of third-party payers have ruled out payment for any treatment — including complications — related to breast implants.”

What to do if those MRI scans detect cracks or breaks in an implant “is another conundrum that’s created by this [FDA] recommendation,” said Erhardt, of Albany, Ga. By calling for costly MRIs to detect silent ruptures and potential replacement surgery in such cases, the FDA is suggesting to patients and physicians that leakage may present safety concerns. “But we still don’t have science that [a silent rupture] creates a harmful situation for the patients. And the FDA hasn’t addressed that either,” Erhardt said. […]

The specialized MRI images required to detect the integrity of a breast implant typically cost between $1,500 and $1,800, said Diana Zuckerman, director of the National Research Center for Women & Families, a nonprofit research and education organization in Washington, D.C. Costs at some centers can reach up to $4,000, and many women would have to travel long distances to get the recommended images, added Zuckerman, whose organization testified against the latest silicone implant approval.

“These young girls are often going into debt that they can’t really afford to get out of, and they’re paying for something on installment that they can barely afford,” Zuckerman said. “I certainly think any woman who is not affluent would be crazy to choose silicone because of the additional cost.” […]

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FDA Ends Ban on Silicone Implants

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David Brown and Christopher Lee, The Seattle Times: November 18, 2006.

The Food and Drug Administration ended its 14-year ban on the cosmetic use of silicone breast implants yesterday, despite lingering safety concerns from some health advocates.

The FDA is requiring that manufacturers tell women that the implants “are not lifetime devices” and that most recipients will need at least one additional surgery to remove or replace their implants. The agency is requiring the makers, Mentor Corp. and Allergan Inc., to conduct an extensive study of at least 40,000 implant recipients over the next decade and provide their findings to the government. […]

Silicone implants were first marketed more than 30 years ago, but a moratorium was placed on them in 1992 after many women who had received them reported pain, deformity and serious illness caused when the implants ruptured or leaked. At the time, the FDA concluded there was “inadequate information to demonstrate that breast implants were safe and effective.” A major implant manufacturer, Dow Corning Corp., was pushed into bankruptcy because of lawsuits stemming from the problematic devices. […]

Diana Zuckerman, president of the National Research Center for Women and Families, said the approval was the product of corporate lobbying rather than good science.

Zuckerman, a former Capitol Hill staffer who has worked on breast implant safety issues for more than 15 years, said too little is known about the long-term health risks of the implants. She said what is known indicates that some women will experience joint pain, chronic fatigue and leakage. […]

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Silicone Implants Backed by FDA Panel

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Marc Kaufman, Washington Post: April 14, 2005.

A Food and Drug Administration advisory panel recommended yesterday that silicone gel breast implants made by Mentor Corp. be allowed back on the market for wider use — a surprise decision that came a day after the same panel rejected the application of a rival company.

Mentor officials were delighted by the panel vote.

In explaining their decision, several panel members said they were more impressed by Mentor’s data on how and why implants rupture and by the lower rupture rate of its implants. While Inamed reported a yearly ruptue rate of about 1.4 percent, the yearly Mentor rate was 0.2 percent — a figure that had been questioned by FDA reviewers.

The panel decision was sharply questioned by Inamed officials, who had been criticized the day before for not having sufficiently long-term data.

“Inamed views today’s panel decision as curious and inconsistent with the decision reached by the panel yesterday on Inamed’s [application] — we look forward to working with Dr. [Lester M.] Crawford and FDA staff on addressing these inconsistencies,” Inamed president and chief executive Nicholas L. Teti said in a statement.

About 260,000 American women had their breasts enlarged with implants last year, and an additional 60,000 had received them after surgery for breast cancer.

Because of health concerns, the FDA in recent years has allowed silicone gel implants to be used only in women who had mastectomies and in some who take part in clinical trials; all others received implants filled with a saline solution. Many women say the silicone gel looks and feels more natural, and it is widely used in other parts of the world.

The panel’s decision was also criticized by some public interest groups, which have long argued that the potential dangers of silicone gel implants remain insufficiently studied.

“I think this was a triumph of wishful thinking which overruled the lack of science,” said Diana Zuckerman, president of the National Center for Policy Research for Women and Families. “Because of all the conditions, it’s far from a done deal regarding the FDA. It’s not helpful to women to have a product approved on the basis of two years of safety data.”

[…]

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Risking Women’s Health

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SF Gate: April 12, 2005.

IT LOOKS as if two California manufacturers just won’t take no for an answer — even if women’s health is at stake.

In their third attempt, Santa Cruz-based Inamed Corp. and Mentor Corp., have submitted applications for FDA approval that would allow them to sell their silicone-gel breast implants to the general public. […]

If approved, the Food and Drug Administration would lift its ban, imposed in 1992, which limited the use of the implants to controlled research.

Lest the FDA and these manufacturers forget, there’s a reason the ban was imposed.

Numerous reports linked the implants to arthritis, vascular disease and a range of autoimmune disorders that followed after the implants ruptured.

“All the data indicates that rupture is inevitable,” said Diana Zuckerman, president of the National Research Center for Women & Families. “What have these companies shown to prove that it is now safe?”

Not much. […]

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FDA Rejects Silicone Gel Breast Implants

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Steve Sternberg, The Associated Press: January 9, 2004.

Silicone breast implants were dealt a new blow Thursday when the Food and Drug Administration rejected Inamed Corp.’s bid to bring them back on the market a decade after earlier versions were ruled unsafe and banned. […]

“There’s additional information that we think is necessary for this product to pass the threshold of what we consider necessary for open marketing,” said Daniel Schultz, the FDA’s director of device evaluation.

Silicone breast implants are now allowed only for reconstruction after breast cancer surgery and in controlled trials for women who want them for cosmetic reasons. […]

Some women say they prefer silicone-filled breast implants over those made with saline because silicone implants have a more natural feel. Critics worry about the long-term health consequences when implants break and leak. They cite studies linking silicone implants with cancer, immune disorders and crippling fatigue. But a 1999 Institute of Medicine analysis found no proof that silicone implants cause severe health problems. […]

“Even the FDA advisers who recommended approval all agreed that we don’t know the long-term safety (of these devices). It’s terrific that the FDA heard that message,” said Diana Zuckerman, president of the National Center for Policy Research for Women and Families, a Washington-based think tank.

Zuckerman hailed a provision in the FDA guidance document calling for the development of new external performance tests that better mimic conditions within the breast. […]

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Silicone Implants Generate Renewed Debate

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Colette Bouchez, HealthDay: August 21 2002.

As federal health officials ready for hearings on whether silicone breast implants should be allowed back on the U.S. market, a 2002 study offers evidence of a reduced rate of implant rupture. The study, conducted by a group of Danish researchers, used magnetic resonance imaging (MRI) to study implant rupture rates in some 300 women for a period of three years. From that data, the researchers extrapolated a rupture rate of 15 percent to 17 percent 10 years after the women received the implants. […]

Diana Zuckerman, a former member of the National Cancer Institute advisory committee on breast implants, says the study offers a gross underestimate of the implant rupture problem.

“If it were truly 15 percent at 10 years, that would be an improvement, but I do not believe for a minute that it is 15 percent. It’s an estimate based on an assumption that I don’t believe this study supports,” says Zuckerman, executive director of the National Center for Policy Research for Women and Families.

Zuckerman notes the research, published in an issue of the Archives of Surgery, only studied women for three years. And without specific 10-year data, there’s no real way to accurately project the rate of rupture across an entire decade, she says.

A study published in 2000 by the U.S. Food and Drug Administration (FDA) found a silicone implant rupture rate as high as 55 percent, with up to 69 percent of all women likely to experience a rupture in at least one breast. […]

“Up until two years ago there were no specific studies done on the health problems of women whose implants ruptured. And when this research was finally conducted, in one study by the FDA and two by the NCI (National Cancer Institute), there was a significant increase in certain health problems in the women with the ruptured implants,” Zuckerman says.

Zuckerman says the findings from the NCI studies were even more troubling. In this research, doctors compared women who had breast implants to other plastic surgery patients, and found the implant group (most of whom had silicone gel implants) were more than twice as likely to die from brain cancer, and three times as likely to die of lung cancer.

“If I were a woman contemplating silicone breast implants, this would sure scare me,” Zuckerman says. […]

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