The conflict between adversary law and scientific data is exemplified by the silicone breast implant story. By 1992, implant surgery had been performed for 30 years, between one and two million women had had the procedure for cosmetic breast enhancement or post-mastectomy reconstruction, and 90 percent of them professed to be pleased with the results. This situation changed abruptly when some articles appeared suggesting an association between implants and scleroderma, a rare disease of connective tissue which stiffens the skin, esophagus, and lungs. Marcia Angell, managing editor of the New England Journal of Medicine, got interested in the subject when the Journal published two articles indicating that implants do not cause disease. Silicone is used in prostheses, catheters, and many medical devices because it produces little or no reaction in the tissues with which it comes into contact.
Implants generally consist of a tough silicone envelope containing silicone gel.
Occasionally the implants leak gel into the surrounding tissues. In the United Kingdom, where judges rather than juries decide cases involving scientific judgment, there has been no such plague of lawsuits. The judicial system there accepted the overwhelming scientific evidence that there is no increased risk of disease from breast implants. Just as the hope and expectation that a treatment will help often alleviates anxiety and improves symptoms, the conviction that some medical procedure has done damage will raise anxiety and aggravate old symptoms or create new ones. Depressed individuals with a generally pessimistic outlook on life have been observed to be the most susceptible to the nocebo effect.