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Posted at 02:31 PM ET, 01/10/2012

Under socialized medicine, U.K. urges private clinics to remove faulty breast implants ‘on moral grounds’

LONDON -- These days, product recalls are nothing out of the ordinary. From children’s toys to Tylenol, you locate the offending item, send in your receipt, and with any luck, get a refund. But when the recall in question concerns a breast implant – as it does right now in a scandal here in the U.K. – then the process is a quite bit more complicated.

In case you haven’t heard, silicone breast implants made with P.I.P. – an industrial grade silicone – by a French company have now been declared faulty, exposing women to ruptures, leaks and possible risks of cancer. Over the past 12 years, some 300,000 of these implants were sold to women around the globe in more than 65 countries, predominantly in Europe and South America. (The United States banned this product and declared it unsafe.)

The French government has recently recalled all P.I.P. implants and agreed to pay for their removal, but only for women who’d had the original surgery done in France. The British government maintains that the link between P.I.P. implants and cancer is far lower than suggested by French data. It has agreed to pay for any removal on implants performed by the National Health Service (NHS) over the past decade (primarily those linked to breast cancer reconstructive surgery). But this accounts for only about 5% of the 40,000
Plastic surgeon Denis Boucq holds a defective silicone gel breast implant manufactured by French company Poly Implant Prothese (PIP) after he removed it from a patient in a clinic in Nice December 21, 2011. French medical device regulatory authority (AFSSAPS) recalled PIP breast implants in March 2010 after it concluded that their performance and safety were not in accordance with current standards. France will offer surgery to remove the breast implants of up to 30,000 women if a study due out this week finds that the silicone they are made from could cause cancer, the health minister said on Tuesday. REUTERS/Eric Gaillard (FRANCE - Tags: HEALTH SOCIETY) (ERIC GAILLARD - REUTERS)
women who’ve had implants in this country during that time.

As for the remaining 38,000 or so cases, the government is urging private clinics to perform the recalls for free on moralgrounds. (As a last resort, the government will step in to pay for removal of implants put in in a private clinic that has closed or is unwilling to provide the service.

And this is where things get interesting. Several of the private British health clinics are balking at this moral directive from the government to undertake these removals for free. The clinics’ argument is that given that a government regulatory body approved the use of P.I.P. in the first place, they should not be financially liable for any ex poste safety concerns, at a cost to them of approximately 2,800 pounds ($4,300) per person.

Which means that the British government – read: taxpayer – may end up shelling out as much as 11 million pounds ($17 million) to solve the problem, unless the private health providers review this decision and change their minds by week’s end.

It’s unclear as yet how this whole thing will resolve and even which way public opinion will tip: will there be more sympathy for the innocent women who risk ruptures and possible cancer than for big business? Or will public opinion choose big business over vanity?

If I had to guess, I’d bet the public will side with women. Still, as an American who’s lived outside the United States for five years and watched tortured health care debates unfold on both sides of the pond, I find this breast implant recall debate fascinating – and illuminating – as part of the ongoing debates over the future of socialized medicine.

For Brits who are just beginning to experiment with private health care, it’s a taste of what we Americans know all too well: a segmented market with two sets of patients. And each set, by virtue of the decidedly different nature of her health care packages (in this case, the “state option” being decidedly more generous) ends up with vastly different health care outcomes. That may sound quite reasonable to an American ear, but to anyone who’s grown up with free and universally available medical care, it’s a bath of cold water.

On the other hand, the whole idea of private doctors having a “moral obligation” to correct the failure of a regulatory body will leave Americans scratching their heads. After all, they’ll surely argue, these doctors performed this procedure in good faith, were told it was safe, and were paid a fee for their services. Why should they fix a problem they didn’t create, much less for free?

But over here in the U.K., there’s a strong sense that doctors – and the health care system more generally – really does have a public health mission that overrides the narrow contract that doctors fulfill when they agree to provide a service, regardless of cost.

And you thought this was just about breast implants?

Delia Lloyd is a London-based journalist whose work has appeared in The New York Times, The International Herald Tribune, The Financial Times, and The Guardian. Previously, she was a correspondent for Politics Daily. Follow her on Twitter at @RealDelia

By Delia Lloyd  |  02:31 PM ET, 01/10/2012

 
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