The controversy reveals that we wrongly assume, with dangerous implications for public health, that women who get breast implants must be rich.
A Venezuelan woman sits next to the two PIP breast implants that she had removed. The yellow implant at left, made by Poly Implant Prothese, had broken. / AP
the past few months, the leak-prone breast
implants of French company Poly Implant Prothese has turned into an international furor. At issue
is the company's use of non-medical-grade silicone, which has an
increased risk of rupture. The gel inside the implant, once released,
can inflame the surrounding tissue. Though there's limited evidence for this, fears
persist about the irritation leading to an increased risk for
cancer. The scope of the potential impact is tremendous. As of last
week, the estimate cited by
the BBC was that "up to 400,000 women in 65 countries are believed to
have been given implants" from the company. PIP founder Jean-Claude Mas is now facing
charges of involuntary injury, while policy professionals, journalists,
and the public are asking how the implants could have made it past
safety inspectors to have reached so many women.
there were ever a time to move beyond our dangerously facile debate about
cosmetic surgery, it's now. European media have been hammering the point that it's time to take implant safety as seriously as
drug safety, and take cosmetic procedures as seriously as any other operations, which is what they
To answer the question of how the
implants could have made it to so many women, though, one has to ask how
and it is that so many women are getting breast implants at all. Paris-based plastic surgery and dermatologist
organization IMCAS recently released some new numbers that help explain. Cosmetic surgeries not only rose by 10.1 percent in 2011 but are expected to
rise by another 11.12 percent in 2012, despite the scare.
A significant portion of the debate touches on a longstanding theme of how people think about cosmetic surgery: who, if anyone, should help cover the costs for removing and replacing defective implants? Though insurance policies and national
governments have already declared themselves willing to foot the bill for the
faulty implants' removal, that doesn't come without caveats. The implicit moral question the responsible officials seem to be asking themselves is, Should governments compensate for losses in botched vanity
projects? And herein lies the need
for a more careful look at the phenomenon of plastic surgery.
France, the government will only pay for new implants if the originals
were for reconstructive surgery. Politicians in Germany have been urging
similar policies. Elizabeth Niejahr neatly summarized this thinking in Die Zeit as "one
shouldn't make cosmetic surgeries even more popular. ... Those who, out
of vanity, decide to undergo the knife, should be aware of the
consequences." SPD Carola Reimann, Niejahr pointed out, has also argued
that "It's about the beauty ideal and the pressure to conform."
These politicians have a point, namely about moral hazard. But behind these sentiments lies a deep confusion about plastic surgery that's worth
surfacing. The idea that implants are for "vanity" seems to imply selfishness and, with it, an exercise
of will. But the charge that implants are about a "pressure to conform" implies the opposite. Which is driving
the trend towards plastic surgery? A projected growth in surgeries,
despite the dire stories of the past year, begins to look like a
pathology not just in individual women and men, but in society itself;
if that's the case, how helpful is it to blame individuals for
succumbing to what appears to be a mass psychosis?
criticizing the French and potential German positions, makes an
important related point: many politicians are assuming that the women
paying for non-reconstructive implants must be rich, and are adjusting
their rhetoric accordingly. But a glance merely at "trash talk shows,"
Niejahr notes, suggests this is "a false picture." How? "There may be many
women who save for new breasts or with what little credit they have
choose a larger chest over a new car."
just an inaccurate image: the suggestion that women who get breast
implants must be rich is a dangerous misconception with real implications. The enormous black market in cosmetic surgery, as
well as the apparently flourishing cosmetic surgery tourism trade -- with
terrifying stories of incompetently executed, dangerous procedures -- should be
evidence enough, even without Niejahr's trashy TV.
This isn't to say that governments should pay
for implant replacements (though Niejahr does make that argument): it's
questionable fiscal policy to pay for implant replacements in the
current European economic climate, even before you get to the possible
moral hazard argument. But in the debate over the appropriate policy
position, European politicians do need to be careful about the
assumptions they convey in their rhetoric.
these few critics in the current Continental debate show, this may be the
perfect time to probe the dark undercurrents of plastic surgery trends.
Tighter regulations may reduce dangers within the European Union, but they don't
change the fact that these surgeries still carry risks -- and they're
definitely not going to help the women who head to Mexico. Double-D
millionaires aren't a public health problem -- but they are a disturbingly convenient fiction.
Long after research contradicts common medical practices, patients continue to demand them and physicians continue to deliver. The result is an epidemic of unnecessary and unhelpful treatments.
First, listen to the story with the happy ending: At 61, the executive was in excellent health. His blood pressure was a bit high, but everything else looked good, and he exercised regularly. Then he had a scare. He went for a brisk post-lunch walk on a cool winter day, and his chest began to hurt. Back inside his office, he sat down, and the pain disappeared as quickly as it had come.
That night, he thought more about it: middle-aged man, high blood pressure, stressful job, chest discomfort. The next day, he went to a local emergency department. Doctors determined that the man had not suffered a heart attack and that the electrical activity of his heart was completely normal. All signs suggested that the executive had stable angina—chest pain that occurs when the heart muscle is getting less blood-borne oxygen than it needs, often because an artery is partially blocked.
Two historians weigh in on how to understand the new administration, press relations, and this moment in political time.
The election of Donald Trump, and the early days of his presidency, have driven many Americans to rummage through history in search of context and understanding. Trump himself has been compared to historical figures ranging from Ronald Reagan to Henry Ford, and from Andrew Jackson to Benito Mussolini. His steps have been condemned as unprecedented by his critics, and praised as historic by his supporters.
To place contemporary events in perspective, we turned to a pair of historians of the United States. Julian Zelizer is a professor of history and public affairs at Princeton University. He is the author, most recently, of The Fierce Urgency of Now: Lyndon Johnson, Congress, and the Battle for the Great Society. Morton Keller is a professor emeritus of history at Brandeis University. He has written or edited more than 15 books, including Obama’s Time: A History. They’ll be exchanging views periodically on how to understand Trump, his presidency, and this moment in political time. —Yoni Appelbaum
Consolidated corporate power is keeping many products’ prices high and quality low. Why aren’t more politicians opposing it?
There are many competing interpretations for why Hillary Clinton lost last fall’s election, but most observers do agree that economics played a big role. Clinton simply didn’t articulate a vision compelling enough to compete with Donald Trump’s rousing, if dubious, message that bad trade deals and illegal immigration explain the downward mobility of so many Americans.
As it happens, Clinton did have the germ of exactly such an idea—if one knew where to look. In an October 2015 op-ed, she wrote that “large corporations are concentrating control over markets” and “using their power to raise prices, limit choices for consumers, lower wages for workers, and hold back competition from startups and small businesses. It’s no wonder Americans feel the deck is stacked for those at the top.” In a speech in Toledo last fall, Clinton assailed “old-fashioned monopolies” and vowed to appoint “tough” enforcers “so the big don’t keep getting bigger and bigger.”
A $100 million gangster epic starring Robert De Niro, Al Pacino, and Joe Pesci has become too risky a proposition for major studios.
Martin Scorsese’s next project, The Irishman, is as close as you can get to a box-office guarantee for the famed director. It’s a gangster film based on a best-selling book about a mob hitman who claimed to have a part in the legendary disappearance of the union boss Jimmy Hoffa. Robert De Niro is attached to play the hitman, Al Pacino will star as Hoffa, and Scorsese favorites Joe Pesci and Harvey Keitel are also on board. After Scorsese branched into more esoteric territory this year with Silence, a meditative exploration of faith and Catholicism, The Irishman sounds like a highly bankable project—the kind studios love. And yet, the film is going to Netflix, which will bankroll its $100 million budget and distribute it around the world on the company’s streaming service.
In late 2015, in the Chilean desert, astronomers pointed a telescope at a faint, nearby star known as ared dwarf. Amid the star’s dim infrared glow, they spotted periodic dips, a telltale sign that something was passing in front of it, blocking its light every so often. Last summer, the astronomers concluded the mysterious dimming came from three Earth-sized planets—and that they were orbiting in the star’s temperate zone, where temperatures are not too hot, and not too cold, but just right for liquid water, and maybe even life.
This was an important find. Scientists for years had focused on stars like our sun in their search for potentially habitable planets outside our solar system. Red dwarfs, smaller and cooler than the sun, were thought to create inhospitable conditions. They’re also harder to see, detectable by infrared rather than visible light. But the astronomers aimed hundreds of hours worth of observations at this dwarf, known as TRAPPIST-1 anyway, using ground-based telescopes around the world and NASA’s Spitzer Space Telescope.
“The question confronting us as a nation is as consequential as any we have faced since the late 1940s,” a group of Republican and Democratic experts write.
Ben Rhodes, one of Barack Obama’s top advisers, once dismissed the American foreign-policy establishment—those ex-government officials and think-tank scholars and journalists in Washington, D.C. who advocate for a particular vision of assertive U.S. leadership in the world—as the “Blob.” Donald Trump had harsher words. As a presidential candidate, he vowed never to take advice on international affairs from “those who have perfect resumes but very little to brag about except responsibility for a long history of failed policies and continued losses at war.” Both men pointed to one of the Beltway establishment’s more glaring errors: support for the war in Iraq.
Now the Blob is fighting back. The “establishment” has been unfairly “kicked around,” said Robert Kagan, a senior fellow at the Brookings Institution and former official in the Reagan administration. As World War II gave way to the Cold War, President Harry Truman and his secretary of state, Dean Acheson, “invented a foreign policy and sold it successfully to the American people. That’s what containment was and that’s what the Truman Doctrine was. … That was the foreign-policy establishment.” During that period, the U.S. government also helped create a system for restoring order to a world riven by war and economic crisis. That system, which evolved over the course of the Cold War and post-Cold War period, includes an open international economy; U.S. military and diplomatic alliances in Asia, Europe, and the Middle East; and liberal rules and institutions (human rights, the United Nations, and so on).
Neither truck drivers nor bankers would put up with a system like the one that influences medical residents’ schedules.
The path to becoming a doctor is notoriously difficult. Following pre-med studies and four years of medical school, freshly minted M.D.s must spend anywhere from three to seven years (depending on their chosen specialty) training as “residents” at an established teaching hospital. Medical residencies are institutional apprenticeships—and are therefore structured to serve the dual, often dueling, aims of training the profession’s next generation and minding the hospital’s labor needs.
How to manage this tension between “education and service” is a perennial question of residency training, according to Janis Orlowski, the chief health-care officer of the Association of American Medical Colleges (AAMC). Orlowski says that the amount of menial labor residents are required to perform, known in the profession as “scut work,” has decreased "tremendously" since she was a resident in the 1980s. But she acknowledges that even "institutions that are committed to education … constantly struggle with this,” trying to stay on the right side of the boundary between training and taking advantage of residents.
Rod Dreher makes a powerful argument for communal religious life in his book, The Benedict Option. But he has not wrestled with how to live side by side with people unlike him.
Donald Trump was elected president with the help of 81 percent of white evangelical voters. Mike Pence, the champion of Indiana’s controversial 2015 religious-freedom law, is his deputy. Neil Gorsuch, a judge deeply sympathetic to religious litigants, will likely be appointed to the Supreme Court. And Republicans hold both chambers of Congress and statehouses across the country. Right now, conservative Christians enjoy more influence on American politics than they have in decades.
And yet, Rod Dreher is terrified.
“Don’t be fooled,” he tells fellow Christians in his new book, The Benedict Option. “The upset presidential victory of Donald Trump has at best given us a bit more time to prepare for the inevitable.”
Plagues, revolutions, massive wars, collapsed states—these are what reliably reduce economic disparities.
Calls to make America great again hark back to a time when income inequality receded even as the economy boomed and the middle class expanded. Yet it is all too easy to forget just how deeply this newfound equality was rooted in the cataclysm of the world wars.
The pressures of total war became a uniquely powerful catalyst of equalizing reform, spurring unionization, extensions of voting rights, and the creation of the welfare state. During and after wartime, aggressive government intervention in the private sector and disruptions to capital holdings wiped out upper-class wealth and funneled resources to workers; even in countries that escaped physical devastation and crippling inflation, marginal tax rates surged upward. Concentrated for the most part between 1914 and 1945, this “Great Compression” (as economists call it) of inequality took several more decades to fully run its course across the developed world until the 1970s and 1980s, when it stalled and began to go into reverse.
The preconditions are present in the U.S. today. Here’s the playbook Donald Trump could use to set the country down a path toward illiberalism.
It’s 2021, and President Donald Trump will shortly be sworn in for his second term. The 45th president has visibly aged over the past four years. He rests heavily on his daughter Ivanka’s arm during his infrequent public appearances.
Fortunately for him, he did not need to campaign hard for reelection. His has been a popular presidency: Big tax cuts, big spending, and big deficits have worked their familiar expansive magic. Wages have grown strongly in the Trump years, especially for men without a college degree, even if rising inflation is beginning to bite into the gains. The president’s supporters credit his restrictive immigration policies and his TrumpWorks infrastructure program.
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