Still, does that matter? It is almost certain that the earth will not be hit by a major asteroid in our lifetime or that of our children. If we don’t take the astronomers’ advice and buy a planetary insurance policy, we’ll collectively save a few bucks and we will almost certainly not regret it. But still—it could happen. And the $400 million cost of the insurance policy is very modest relative to how much we spend coping with other risks. For that reason, Richard Posner, a U.S. appeals court judge and public intellectual known for his hard-nosed economic analysis, thinks the astronomers should get their funding. “The fact that a catastrophe is very unlikely to occur is not a rational justification for ignoring the risk of its occurrence,” he wrote.
The particular catastrophe that prompted Posner to write those words wasn’t an asteroid strike, however. It was the Indian Ocean tsunami of 2004. Such an event had not happened in the region in all of recorded history, and the day before it actually occurred, experts would have said it almost certainly would not happen in our lifetime or that of our children. But experts would also have said—and in fact did say, in several reports—that a tsunami warning system should be created in the region because the cost is modest. The experts were ignored and 230,000 people died.
That disaster occurred three weeks after the Canary Islands conference on asteroids ended. Just hours after waves had scoured coastlines from Indonesia to Thailand and Somalia, Slava Gusiakov, a Russian expert on tsunamis who had attended the conference, sent an emotional e-mail to colleagues. “We were repeatedly saying the words low-probability/high-consequence event,” he wrote. “It just happened.”
5
A Story About Numbers
Japanese prostitutes were the first women to connect silicone and plumper breasts. It was the 1950s and American servicemen in Japan preferred breasts like they knew them back home, so prostitutes had themselves injected with silicone or liquid paraffin.
The manufactured silicone breast implant followed in the early 1960s. In 1976, the United States Food and Drug Administration was given authority over medical devices, which meant the FDA could require manufacturers to provide evidence that a device is safe in order to get permission to sell it. Breast implants were considered medical devices, but because they had been sold and used for so many years without complaints, the FDA approved their continued sale without any further research. It seemed the reasonable thing to do.
The first whispers of trouble came from Japanese medical journals. Some Japanese women were being diagnosed with connective-tissue diseases—afflictions like rheumatoid arthritis, fibromyalgia, and lupus. These women had also been injected, years before, with silicone, and doctors suspected the two facts were linked.
In 1982, an Australian report described three women with silicone breast implants and connective-tissue diseases. What this meant wasn’t clear. It was well known that implants could leak or rupture, but could silicone seep into the body and cause these diseases? Some were sure that was happening. The same year as the Australian report, a woman in San Francisco sued implant manufacturers, demanding millions of dollars for making her sick. The media reported both these stories widely, raising concerns among more women and more doctors. More cases appeared in the medical literature. The number of diseases associated with implants grew. So did the number of stories in the media. Fear spread.
In 1990, an episode of Face to Face with Connie Chung aired on CBS. Tearful women told stories of pain, suffering, and loss. They blamed their silicone implants. And Chung agreed. First came the implants, then came the disease. What more needed to be said? The tone of the widely watched episode was angry and accusatory, with much of the blame focused on the FDA.
That broke the dam. Stories linking implants with disease—with headlines like “Toxic Breasts” and “Ticking Time Bombs”—flooded the media. A congressional hearing was held. Advocacy groups—including Ralph Nader’s Public Citizen—made implants a top target. Feminists—who considered breast augmentation to be “sexual mutilation,” in the words of best-selling writer Naomi Wolf—attacked implants as a symbol of all that was wrong with modern society.
Under intense pressure, the FDA told manufacturers in early 1992 that they had ninety days to provide evidence that implants were safe. The manufacturers cobbled together what they could, but the FDA felt it was inadequate. Meanwhile, a San Francisco jury awarded $7.34 million to a woman who claimed her implants, manufactured by Dow Corning, had given her mixed connective-tissue disease.
The FDA banned silicone breast implants in April 1992, although it emphasized that the implants were being banned only because they had yet to be proved safe, as the manufacturers were required to do, not because they had been proved unsafe. The roughly one million American women with the implants shouldn’t worry, the FDA chief insisted.
But they did worry. Along with the successful lawsuit, the FDA ban was seen as proof that the implants were dangerous. The media filled with stories of suffering, angry women and “the trickle of lawsuits became a flood,” wrote Marcia Angell, editor of the New England Journal of Medicine at the time and the author of the definitive book on the crisis, Science on Triaclass="underline" The Clash Between Medical Science and the Law in the Breast Implant Case.
In 1994, the manufacturers agreed to the largest class-action settlement in history. A fund was created with $4.25 billion, including $1 billion for the lawyers who had turned implant lawsuits into a veritable industry. As part of the deal, women would have to produce medical records showing that they had implants and one of the many diseases said to be caused by implants, but they didn’t have to produce evidence that the disease actually was caused by the implants—either in their case or in women generally. “Plaintiffs’ attorneys sometimes referred clients to clinicians whose practice consisted largely of such patients and whose fees were paid by the attorneys, ” wrote Angell. “Nearly half of all women with breast implants registered for the settlement, and half of those claimed to be currently suffering from implant-related illnesses.” Not even the mammoth settlement fund could cover this. Dow Corning filed for bankruptcy and the settlement collapsed.
The transformation of silicone implants was complete. Once seen as innocuous objects no more dangerous than silicone contact lenses, implants were now a mortal threat. In surveys Paul Slovic conducted around this time, most people rated the implants “high risk.” Only cigarette smoking was seen as more dangerous.
And yet, at this point, there was still no scientific evidence that silicone breast implants actually cause connective-tissue disease or any other disease. As late as 1994, there wasn’t even a single epidemiological survey. “What we saw in the courtroom and in much of the media,” wrote Angell, “were judgments based on anecdote and speculation.”
This dramatic sequence of events was driven by many things, naturally, but the most critical was not the chemistry of silicone, the biology of breasts, the tenacity of activists, the rapaciousness of lawyers, the callousness of corporations, or the irresponsible sensationalism of the media. No, the most fundamental factor was the simple fact that humans are good with stories and bad with numbers.