Talk:Breast implant/Archive 2

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Independent Studies

Some of us are not going to give up on providing a NPOV here. Plastic surgeons will not succeed in painting silicone implants as totally safe, or themselves as unbiased. There WERE problems with the Danish studies and they WERE funded by DOW. Irritation that we mention that is unfortunate, but it won't change the article.

The FDA study was NOT funded by DOW. It was funded by the Office of Women's Health, FDA; the Office of the Commissioner; the National Cancer Institute, NIH; the Office of Research on Women's Health, NIH; and the U.S. Department of Health and Human Services.

That is a more independent study than that funded by implant manufacturers.

HOWEVER, I DID add the Danish study back into the equation, under Systemic Illness. I used the study findings, and quoted some of an article written by an epidemiologist who has written extensively in this area.

The Danish studies were funded by the Danish Cancer Registry and and an organization which recieved contributions from Dow. It is not a "Dow" study. The exact indirect funding from Dow is declared in that article and their exclusion from particpation, data collection, and funding is outlined. The FDA study is not "better" as you imply but stands out because it is not consistant with other studies done before and after from the United States, Denmark, Finland, and Australia from doctors and researchers from multiples disciplines. Read the review article on this written from the Vanderbilt dept. of precentive medicine and epidimiology and they go thru in detail why the Brown study conclusion is flawed in retrospect. Your cutting and pasting on this was lifted from a decidely anti-silicone website that is more political then medical

Droliver 15:52, 1 April 2006 (UTC)

Dr. Oliver, You edited out information that Dr. Zuckerman wrote. I added some of it back in. The FDA study is more independent than studies funded by Dow Corning - even those that were funded only in part. Dow has funded many studies, which does tarnish the independence. This reminds me of many of the tobacco studies that were funded by the tobacco industry. The FDA study was also multi-discipline. The FDA study was NOT funded by DOW. It was funded by the Office of Women's Health, FDA; the Office of the Commissioner; the National Cancer Institute, NIH; the Office of Research on Women's Health, NIH; and the U.S. Department of Health and Human Services.

Your link to the Danish study does not have the footnote that you and Dr. Zuckerman reference. I do not have access to the full article. Yet it appears there is controversy about the funding of it. How much was funded by Dow, in 'contributions'? This is relevant information, particularly when the study slashes the FDA study that is independent. Why don't you state what percentage was funded by Dow, in the form of 'contributions'? And specify what articles you refer to from Australia? From what Dr. Z states, both the Denmark and Finland studies were funded in part by Dow, and even authored by some of the same people. The article that you state is 'decidely (sic) anti-silicone' was written by an epidemiologist.

I agree with you that the "tasteless" photo was tasteless. Yet a 17 year old boy clearly didn't think it was tasteless. If it was a real photo which the author swears it is (not likely), it is a good example of the absurd extent of some plastic surgery. Fodder for adolescent boys, but hardly safe or life-saving surgery,. Plastic surgeons went so far as to invent names for small breasts, which they have called 'deformities'. Jgwlaw

Whether it reminds you of tobacco studies or not is immaterial.

"You" are reaching Oliver. This is a discussion board, remember? I am entitled to my opinion here. The Dow funded studies are very much like the bogus "Tobacco Research Institute" of years ago, which always found that cigarettes are safe. Now of course I did not add that to the article. However, what IS relevant is information about studies that are funded by manufacturers.

I understand that your business is breast implants, but the fact is implants are still a controversial subject, whether you like it or not. Jgwlaw

Professional review boards of experts in the field (whose job it is to steward their respective journals) and National health boards in Denmark have not suggested author study bias in the design or results. Their work replicates and validates a number of other similar studies. The author's declaration on funding is standard procedure to preemtively address accusations of ulterior motive or funding & is required by all major journals and at all society meetings and events.

You don't know this, and you speak in generalities. I note that the FDA study is still on the FDA website, so evidently it has not been dismissed as readily as you would dismiss it.

Further, it is most pertinent to mention that Dow funded a study. There is NO harm in stating that it was funded by Dow. It is most interesting that these 'studies' so ridicule an independent FDA study. The FDA study was NOT funded by DOW. It was funded by the Office of Women's Health, FDA; the Office of the Commissioner; the National Cancer Institute, NIH; the Office of Research on Women's Health, NIH; and the U.S. Department of Health and Human Services.

Dow has funded entirely too many studies which (surprise) always claim silicone implants are safe. Isn't it astonishing how a non-Dow funded study comes up with different findings? It is a fact that that Dow funded the Danish studies. It is also a fact that the FDA study was not funded by any manufacturer. We will leave the information, and let people make up their own minds. You can continue deleting it, but it will continue to be added. Jgwlaw

The exact text reads:

This study was funded by the International Epidemiology Institute, which in turn received funding from the Dow Corning Corporation, Midland, Mich., and by the Danish Cancer Society. The external funding source (Dow Corning Corporation) had no role in or access to the study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit it for publication. Droliver 21:02, 1 April 2006 (UTC)

Yep, funded by Dow. You also failed to state what Australian article you refer to.

I also added this back in. This is definitely relevant but you chose to delete it, evidently because it did not support your agenda. It also is peer reviewed. "Pathology reports of ruptured implants often show giant cell formation indicating an immune response, as well as chronic inflammation. In a 2004 article in the Journal of Autoimmunity, scientists reported patients with implants demonstrated statistically significant elevation in anti-silicone antibodies compared with the unimplanted control groups. The highest anti-silicone antibody levels were measured in implanted women with either frank implant ruptures or leakage of their silicone gel implants."

Have you seen many pathology reports of women with ruptured implants? This is extremely common. To delete this, along wtih the peer reviewd study is dishonest, and politically biased. Jgwlaw

Typically, studies list at least some potential conflict of interest issues, especially where previous conflicts have raised enough contention to bring disrepute upon similar study findings. The article should not be deficient in this regard, especially in this case, given the large numbers of women who have developed severe autoimmune disorders in the past due to implantation of copious amounts of a foreign substance, one which the body inherently has no clue about handling. This sort of study has increasingly fallen into the realm of junk science, as corporatist researchers have brought cascades of shame down upon once prestigious medical journals. This sort of disclosure is just a no-brainer, common sense, and absolutely essential since the dubious report is most likely going to remain. In this case, the disclosure ought to remain as well. Ombudsman 23:56, 1 April 2006 (UTC)

The International Epidemiology Institute (IEI) has conducted almost all the research on breast implants. All are funded by Dow Corning. Many millions of dollars are involved, regardless of whatever other funding may have been made available. And, all the Dow-funded studies "conclude" that breast implants are safe, even when the data quoted in the article indicate serious problems, such as rupture and chronic breast pain. The IEI receives millions in funding from other corporate entities as well, and those studies also are very favorable to the products made by those companies. The editors of the Journal of the American Medical Association have criticized this type of activity, where an entire body of research literature is funded by a company with a vested interest in the findings. As is typical, the names of many different researchers are listed as authors of dozens of articles to obscure the fact that it is all coming from one funding source.

I was trained in epidemiology as a post-doc at Yale Medical School, and subsequently conducted research at Harvard. I am very careful with my scientific facts in my edits. It's very frustrating when even the simplest facts in a Wikipedia article are repeatedly edited out by someone who either does not know the facts or disagrees with them. A difference of opinion is fine. The editing out or changing of facts is not. I appreciate the Ombudsman's help in trying to protect the integrity of this article. 71.252.91.236 18:43, 3 April 2006 (UTC)DMZ

Once the Implants Go In, Who Cares Where They Come Out

I don't think disease etiology & pathology are typically a plastic surgeon's specialty. I was able to locate my original PS and asked him if he thought silicone implants could cause autoimmune disease. He said he didn't know. At least, that was a truthful response. He just put 'em in. Didn't take 'em out. Or worry about the effects of 'em.

Reminds me of Tom Lehrer's song with lyrics, "'Once the rockets go up who cares where they come down. That's not my department', says Wernher von Braun." Jgwlaw 02:04, 2 April 2006 (UTC)

WE CARE ABOUT IMPLANT REMOVAL

We host a website and forum to provide support and information for women who are not happy with breast implants. There is a lack of honest information about explantation of breast implants and most women are told they will never be able to successfully remove their implants. This is not the case, and we are receiving thousands of hits to our site, posts on our forum and private e-mail which suggests that a huge number of women would rather remove their implants, if possible.

For before and after photos and personally written accounts of explanted women, go to: http://www.explantation.com

It would not be fair to have a discussion about implants without covering those who are unable to keep their implants for many valid reasons. Some women can no longer handle the rising cost of maintaining their implants, of having many discomforts from the complications and risks of implants and of hearing that they will be deformed if they remove them. Coverage of women on the down side of the statistics is grossly lacking, and seriously contributes to the notion that all women are ecstatic about their augmentation.

We also urge plastic surgeons to become more skilled in removing implants properly and repairing the damage done to women from having implants. Drs. are continually insisting to their patients that they will be deformed if they remove their implants and will loathe their appearance. This illustrates an extreme lack of knowledge and skillful training in the area of explantation. This needs to be addressed and changed. Our site shows a phenomenol list of successful explantations and positive testimonies.

We also list patient recommended surgeons who are experienced in removing implants properly. Our site is NOT physician nor manufacturer funded, so our only agenda is information and support for those women who are miserable with their implants, need to replace aging implants, or simply want to remove them. Jeena_el 10:20, 6 April 2006

Dr Henry Jenny

Dr Jenny invented saline implants because of his concern about silicone. He wrote an entire book on the subject. The plastic surgeon who changed that entry to say saline implants were invented for ease of smaller incision was incorrect. Moreover, he didn't even identify himself, but instead wrote anonymously.

I could guess or identify from history who made th eanonymous/unsigned comment above... would that be ironic? What I'd actually like though is to ask for the reference - WP custom for books is to give the author (which is there) the title, which is not, and the ISBN which makes it even easier to find than the author and title. Adding the publisher and the year of publication is icing on the cake, but does no harm. May we expect that with this and future references, please? (WP policy explicitly allows not really anonymity, but pseudonymity, however it does firmly request a signature with 4 tildes otehrwise comments fall apart into unintelligibility.) Midgley 22:24, 3 April 2006 (UTC)

That sounds like a thinly veiled insult, which would violate WP (civility).

The person who previously attributed an incorrect reason for Jenny's saline implant gave no source at all, yet you did not object to that. Why?

Jenny's book is entitled "SiliconeGate". Dr. Jenny is an outspoken critic of silicone implants. The book is not, in my opinion, a particularly well written book, but Dr. Jenny made it astutely clear that the reason he invented saline implants was because of his concern about silicone implants. To say otherwise is simply incorrect. Jgwlaw 05:00, 4 April 2006 (UTC)

Length and Balance

I don't want to incite the Wikipedia:Cleanup because that function is under a more serious crisis. However, this article could use some prudent editing for length (e.g. break out "breast implant risks" into a separate article) and for balance (e.g. genuine risks of breast implants deserve documentation, but so also do implant benefits. BA is not the 3rd most common surgery in the world because women are masochistic, but because they choose the body shape preferably). See Wikipedia:Article size, Wikipedia:Long article layout, and Wikipedia:How to break up a page.

I don't think anyone ever suggested women are masochistic. That came from left field! Further, the benefits of breast implants are obvious, but the risks are not as obvious. Moreover, the benefits have been discussed in the article. Perhaps also this author would like to identify himself, instead of criticizing anonymously? Jgwlaw 02:40, 4 April 2006 (UTC)

• 1. Whilst sorting out the mess of references, apparent a whole paragraph duplicated on the UK Silicone Review Group (see end of here)
  2. Indeed the whole discussion on the Canadian Panel given in Breast implant#Risks and controversy seems somewhat duplicated in the later sub-section Breast implant#Systemic Illness.
  3. Having set out the FDA & Health Canada assessments in 2005, the Breast implant#Risks and controversy concludes with "Dr. Frank Vasey ... recently had this to say...", yet the quote is from his article in 2003 and so can not be a commentary on what has just been discussed in the section. This gives (an unintentional, I trust) POV slant to the section. By time-line, this paragraph should be located higher-up in the section - Anyone care to so do and correctly integrate ?
  4. Finally there is a discrepency over the concerns for polyurethanes. The reference quoted for the raising of the concern was published in 1998 (ref No 2), yet the advice that the article currently implies was then given by the FDA is from a source in 1995 (ref No3). I presume that the FDA in 1995 was replying to a concern raised earlier, if so, then that earlier source should also be given (i.e. placed in this article just before the Ref No.2 ). David Ruben ^Talk 16:55, 4 April 2006 (UTC)

Thanks David! I changed the Vasey sentence and deleted 'recently' - although, arguably 2003 is recent. I did add 2006 research which was later vandalized and sent to the bottom. I restored that section to its proper place. I'm not sure about the polyurethane concern - I do not believe that was my edit. I'll see what I can find out. It is a little difficult to edit this piece, since anonymous authors continue to vandalize it. I really appreciate your constructive criticisms and help !! Jgwlaw 19:29, 4 April 2006 (UTC)

Proposal to split article

In the absence of a total rewrite, the biggest improvement to this article would be a split for the reasons given below. In addition I think a split would also allow (as both an opportunity and as a restructuring requirement) for an easier rewriting of some parts of the topic.

1. Description of what a breast implant is (history, types, indications, short & long-term accepted risks) remain under Breast implant
2. Breast implant controversy or Breast implant risk or Breast implant debate (I have little personal preference) is then a new article that is less a non-contentious description and more of a commentary on a number of debates both historical and topically ongoing. In part the controversy is:
   1. A descriptive piece about specific concerns (including suggesting research and subsequent studies to look further into these) which is a scientific/epidemiology discussion
   2. A historical review. e.g. whether or not rheumatic disorders are so caused, the raising of the concept of the concern can not be disputed as a historical event nor the FDA’s revoking of licenses (whether or not the eventual evidence confirms or refutes the need to have done this).
   3. The "controversy" has had an effect on the purely descriptive aspect of discussing implants (affected what type of implant previously & currently used), so there is some overlap.
   4. Finally the "controversy" might be seen as part of the loss of "blind faith" in the automatic assumption of benevolence of "Medicine" and "Doctors" that was perhaps previously the case in the early & middle parts of the 20th century. No I do not see "anti-implants" as part of a wider anti-medicine movement (I might be wrong, given some editor's comments), but unquestioning acceptance of authority/professionals was clearly risky, and now seems a little naive in these more "enlightened" times. However automatic assuming malevolent malintent (conspiracy) is clearly also unsettling both personally and for social cohension. I’d like to think mankind will eventually follow "assume good faith, but require healthy precautionary scepticism" rather than "expect harm unless provide overwhelming support"

I was very tempted to be bold, but this is a contentious topic and a number of editors have been heavily involved for some time, so "as the newbie", I welcome votes/comments please :-) David Ruben ^Talk 00:13, 5 April 2006 (UTC)

There is no 'accepted' consensus about long term risk. The very most recent research on platinum exposure of women who have had implants is due out this May 1. The US FDA is now reviewing this and may delay their decision on silicone implants. Therefore, there should be a link in the BI entry to the other article, stating that controversy exists about long term risk. Truly local risks, such as infection, capsular contracture, the mechanics of rupture etc., are probably not overly controversial.

You are correct in your thought that 'anti-implant' is not part of a wider anti-medicine movement. The suggestion by another editor's comments is simply ludicrous. I would agree that unquestioning acceptance of any professional is risky. This is particularly true of medical doctors, for obvious reasons. The inherent risk is greater than in many other professions.

A concise summary might be "Trust but verify". This is true of the profession as well as for individual doctors. It is healthy to question, and dangerous not to - as we have historically learned.

Votes

• Split. Too long and gets too quickly into detailed complicated arguements. Suggest split the factual description of what they are, from subsequent/ongoing controversy. Each can have a brief description + link to the other.David Ruben ^Talk 16:55, 4 April 2006 (UTC)

• Uh, that tactic seems to be likely to water down the main article, as has happened with thimerosal, though some degree of reality was restored when a timeline was introduced there. There are Wiki guidelines about pov forks laying around somewhere, but the only thing those seem to be used for is for suppression of politically incorrect articles. Please be careful, as misleading medical industry fluff may be all that remains after splitting; i.e., little will have been accomplished except a trek back to square one. Ombudsman 01:08, 5 April 2006 (UTC)

There are facts about breast implants and there are opinions about breast implants. The problem is that people who have opinions can't agree on the facts. For example, the implant companies' own data, presented publicly to the FDA, report very high complication rates -- about half the breast cancer patients need additional surgery to fix implant problems within 3 years. But those facts -- based on the companies' own data -- are rejected by plastic surgeons. I don't think trying to split the article in 2 is a good solution. We should try to keep a balanced article with references to the facts. Diana Zuckerman, PhD

After considering this, I also do not agree with splitting the article. I can see where it would be headed - the 'risk and controversy' would be soon marked for deletion. I see now what Ombudsman meant. And, plastic surgeons have already tried to make the BI entry an advertisement for their wares. The article should be kept as one article.Jgwlaw 07:34, 9 April 2006 (UTC)

Comments

• Given the differing POVs of those who do/do not belief there are proven risks, might not each side find one of the suggest names of Breast implant controversy or Breast implant risks pejorative ? Breast implant debate might be misconstrued in non-medical terms, i.e. “can one tell natural vs. implants ?” or “should teenagers be allowed to request implants ?” which are all valid issues, but rather separate from whether they are inherently safe or not. Breast implant risk debate might be more NPOV (and less likely to need rewording whatever future studies prove or disprove), but it seems rather long-winded. David Ruben ^Talk 00:31, 5 April 2006 (UTC)
• Ombudsman, I do not envisage this being a fork for "Pro" and "Con", but rather a definition of what they are/indications/description of operative proceedure/post-op recovery/likely commonly expected side effects (pain, bruising, swelling) (much of which is currently missing from article) with clear links to the much more extensive (in length & detail) article about long-term risks (scientific evidence for & against as per curent article) and details on history/regulation. Article currently exceeds 32Kb, and indeed additional info of UK restrictions in light of the "concerns" could be expanded. So overall, I see more, rather than less information on the overall topic, but I agree some care needed to prevent forks covering exactly the same areas from opposing POV.David Ruben ^Talk 01:36, 5 April 2006 (UTC)

David, I am curious why you place the word 'concerns' in quotes? Anyway, how about "Breast Implant - Risk & Controversy"? I agree that we should not include the long term risk (or lack thereof) in the main BI article. However, I think the history of various types of implants could well stay in the BI main article. The 'Risk & Controversy' could discuss the regulation, thus getting into the concerns (not in quote) and controversy.Jgwlaw 07:24, 7 April 2006 (UTC)

• Yes, that's the type of division I envisaged doing in the next few days. I placed "concerns" in quotes for 3 reasons - firstly as it is a subject/topic (ie re BIs, rather than worries about the article), secondly because concerns is subjective (POVs ranging from no concerns, some, moderate, fairly convinced to believe risks verified) - I guess those at either extreme have no concern as believe questions answered. I was therefore being lazy and trying to indicate the word without having to take as much care about whether my use of the word was as well phrased as it might be (re POV/NPOV). Finally and less importanty, I used quotes as there is both the specific epidimiological facts/research and also a historical process over the last few decades (of concerns being raised, studies undertaken, and either side involved in a debate) which also needs be/is mentioned in the article.
• Your suggested title of Breast implant - Risk & Controversy is not bad, but might suggest acceptance of risks as proven, removing the "and" seems more NPOV to me, but would seem poorer English than your suggestion. Some input from others re choice of name appreciated, also can people advise on a few queries re wikstyle of article names:

• Lower case I believe is generally prefered; i.e. Breast implant - risk & controversy  ?
• Use of "&" ampersand or "and" in name; i.e. Breast implant - risk and controversy ?
• Use of dash for a sub-topic, or enclosed in brackets; e.g. Breast implant (risk and/& controversy) ?

• No point having this vote & comments for split, if next week need set a new vote on renaming to correct wikistyle article name... :-) David Ruben ^Talk 14:59, 8 April 2006 (UTC)

Didn't know the word 'concerns' was a subject/topic. Anyway, there is no need for quotes. The concerns are raised - there is no disputing that. Whether they are valid is still controversial.

Accuracy

This article no longer looks like an advertisement for breast implants, which it did earlier. However, itt would be helpful if those who edited the article would identify themselves. Factual inaccuracies will continue to be edited.Jgwlaw 12:52, 4 April 2006 (UTC) Most egregious was a vandal's bald assertion that women do not improve upon removal of ruptured implants. This is factually incorrect. The person who deleted the original statement and wrote the opposite did not back it up and cannot back it up.

Latest Research

I included the most recent research on platinum. I specified the journal and article title, but am looking for an internet link to it. Jgwlaw 12:53, 4 April 2006 (UTC)

"Natural" breast enlargement

Worth mentioning? [1] - FrancisTyers 22:28, 4 April 2006 (UTC)

Absolutely!! Perhaps in another topic? Are you thinking tram flap surgery etc? I know of no 'natural' enlargement, per se, except maturity.  ;-)Jgwlaw 22:56, 4 April 2006 (UTC)

Nope, I mean like growing an implant.

US scientists say they have made a breakthrough to produce natural breast implants using human stem cells.

Read the link :) - FrancisTyers 08:32, 5 April 2006 (UTC)

Sorry, I completely missed it. That is interesting!Jgwlaw 07:27, 7 April 2006 (UTC)

This is still experimental. Diana Zuckerman, PhD —Preceding unsigned comment added by Drzuckerman (talk • contribs) 19:33, 8 April 2006

Yup, thats what the article says. - FrancisTyers 19:52, 8 April 2006 (UTC)

Multiple roll back revert

The revert just done (here) was due to blatent POV pushing. The majority viewpoint is that inplants are safe and without significant associated risks and this de facto is the view amongst most doctors and a position taken by the regulatory bodies. Of course concerns should be raised - the majority might be wrong, and the issues given fair coverage in this encyclopedia. However this is just an encyclopedia which should report on the issues and not be a soapbox for arguing cases. So, whilst I accept others may have better knowledge of all the studies, the language needs remain NPOV. Examples from recent revert:

• Under Systemic Illness Conflicting studies became Poor and often invalid clinical data - this is personal opinion being expressed (unless can cite an authorative assessment of the past studies)
• (IOM) concluded that there was not "sufficient evidence for an association of... became attempted to portray that there was not "sufficient evidence has associated..., clear POV pushing, as well as gramatically incorrect loss of some words at the end.
• The panel found that both companies provided appropriate information to show that silicones are not immunosuppressive materials and while there was no evidence to support a link between silicone gel breast implants and specific connective tissue diseases, were deleted in their entirity, yet such rebutals of an evidence of effect is required for overall balance of the article (I think the article overall is far too long, but that requires either symetrical reduction, or splitting article as suggested above)
• In Additional Surgeries section, adding infection (often very serious) is out of place in a list/discussion about long-term consequences/management of silicon leakage. Any operation can have post-operative infection which may be serious. I am not aware that there is special risk of infection for breast inplantation proceedures or that infections may occur after many years(correct me if I am wrong). The choice of phrasing, in light of other edits, therefore seems scare-mongering.
• To be fair, Reoperation rates of breast reconstruction cases are simular to those of augmentation patients is an improvement on are more frequent in breast reconstruction cases, but neither is accurate given the article quotes rates of 26% of augmentation and 16% of reconstruction surgeries were for replacement of implants which seem about a third less rates for reconstruction cases.

For the majority of inplants the indication is cosmetic, and as such much higher degrees of safety need apply (given that not "medically necessary"). The issues and research on this topic is interesting, and I have learnt a lot reading some of the article's discussion & references given, but editors with strong beliefs will be able to ensure all non-trivial viewpoints are correctly included, provided they do not jeopardise their editing by blatent POV pushing phrasing :-) David Ruben ^Talk 23:19, 4 April 2006 (UTC)

I'll leave the split tag on the page and the vote/comment section running for some days (not sure if there is a policy/guideline on how long), and see what editors suggest :-) David Ruben ^Talk 11:11, 5 April 2006 (UTC)

My suggestion is not to split the article. I now see what Ombudsman's concerns were.Jgwlaw 09:29, 9 April 2006 (UTC)

There is still a great deal of controversy about breast implants. The most recent research raises serious questons about platinum which BI manufacturers had insisted was safe. This is from today's Washington Post:

In their paper in Analytical Chemistry, considered a top journal of the field, researchers Ernest Lykissa and Susan Maharaj reported finding the highest platinum levels to date in women who had implants. They also wrote that for the first time, they found the platinum -- which had leached out of the implants -- in a transformed, oxidized state that makes it potentially more harmful. Implant manufacturers have said for years that their platinum is not harmful, and when the device is manufactured, they are correct," said Lykissa, a forensic toxicologist with the firm ExperTox in Deer Park, Tex. "But in the body, we know that the implants degrade and the platinum can disperse and take on a more reactive form."'

The greatest problem with silicone breast implants is that an entire group of doctors (plastic surgeons) directly benefit financially from their use. This is unlike past controversies over cigarettes and asbestos, for example. There are many good plastic surgeons, but it is disturbing that some lobby for implants with little regard for women's health.Jgwlaw 04:52, 7 April 2006 (UTC)

"Many favorable reviews" simply equals Dow funded marketing fulminations, and is a fine example of ignoring reality. The mainstream view is often Keystone Kops laughable, and must be presented in an npov manner; the Wiki is not Pravda. Neither has there been anything suggesting a retreat by the aggressors; not surprising, since no one in their right mind would dare to defend the proposed reintroduction of silicone. Dow's bold and unconscionable attempts to revive the discredited use of silicone would be almost as absurd as the reintroduction of thimerosal in vaccines and mercury in dental amalgams, but oh, yeh, those iatrogenic nightmares are still on the market (for some mysterious reason). Proper outlining of the controversy does not equate with a politically correct whitewash, especially scrubbing pushed by those who might have to admit that their edits are biased by conflict of interest problems. Ombudsman 21:46, 5 April 2006 (UTC)

Agreed, Ombudsman. It is not the first time that Dow has been less than honorable about its products. And, the conflict of interest with plastic surgeons is obvious. However, I have known a number of plastic surgeons who keep an open mind, and have treated and helped many women remove their implants (without replacing them). As to the autism controversy, I wish I knew more about the autism & thimerosal issue... I just don't.Jgwlaw 05:36, 7 April 2006 (UTC)

Breast Implant Promotions

This article is not a promotion for plastic surgeons. The POV illustrated by the plastic surgeon here is breathtaking, as is the personal attack by name on another editor. POV is demonstrated by plastic surgeon's deletion of the context of the WAPO article. He entirely deleted the fact that the critic of the study was a paid consultant to Inamed -- a fact which the Washington Post article specifically pointed out. Furthermore, the plastic surgeon chose instead to elaborate on the Inamed consultant's credentials, ignoring the credentials of the study researchers. This is the most blatant POV I have seen yet -- except, of course, for the original writing by the same plastic surgeon that read as an advertisement for breast implants and tort "reform". It is inconceivable that he was allowed to do this for so long. I deleted multiple small studies or studies that were not fully explained. If these studies are to be presented, they need to be presented in a balanced manner. The plastic surgeon deleted all previous attempts to do so. Therefore, those studies are deleted in their entirety. I also deleted case reports, since Plastic Surgeon seemed to find case reports objectionable (but only when they differed from his POV).Jgwlaw 06:56, 9 April 2006 (UTC)

Rheumatology section

Whilst I disliked the bulk removal of info on studies if full details could not be given (an encyclopedia does not need to give full details, but rather summarise and link to original sources if the reader wishes to delve deeper), the original consisted of a long list of rather repeatative (to read) paragraphs. Whilst on one hand it is POV to discard all the studies, equally it fails to be NPOV if, as a collection, the critisms can not be made clear.

I have therefore put the reports into a list that highlights meta-reviews, retrospective and the better (study wise) follow-up studies. These are then clearly a "block of information" whose details need not impede the reader from traversing through the article as a whole. The FDA's comments about methodological issues (re duration of studies) then clearly applies as a whole to the process of conducting any study.

This 'chart' highlights only one side of the studies. If you want to add a chart, then you need to include studies that disagree. This was not done. To highlight as a chart only one result is POV.

Jgwlaw 18:53, 9 April 2006 (UTC)

The info on cancer risks seemed absent from the section, so I restored, but I wonder if this is not better in a different section ?

It should be in a different section, and I added a different section title. Not sure if "Oncological" is the correct term, but trying to be consistent with "Rheumatological" and "Neurological".Jgwlaw 18:53, 9 April 2006 (UTC)

I have therefore tried to do 2 conflicting tasks - be inclusive, but also restrictive in how an encyclopedia article should look. An alternative might have been a bulleted-list, but a table seemed neater and likely to encourage shorter summarisation. I hope I struck a reasonable balance ? David Ruben ^Talk 16:05, 9 April 2006 (UTC)

I am open to restoring a chart, but it must be NPOV - including criticisms and funding. This was not done.Jgwlaw 18:53, 9 April 2006 (UTC)

I also restored the accurate summary of the WAPO article , which the plastic surgeon deleted. PS also highlighted academic credentials of Inamed chemist, but omitted qualifications of the study's chemists. Neither are appropriate. Nowhere else is this done. The WAPO article specifically points out the criticism was made by chemists associated with implant makers. To omit this is dishonest. I also included the partial funding of the study.Jgwlaw 18:53, 9 April 2006 (UTC)

Finally, I would like to add that Oliver refuses to engage meaningful discussion. Instead, he just vandalizes the article. This behavior is unprofessional and extremely biased.Jgwlaw 18:54, 9 April 2006 (UTC)

1. How much more NPOV can you get then to quote the conclusions of the major literature and reviews verbatim? This is the mountain of evidence on this subject laid out with links attached so people can see it for themselves. It's quite powerful and I know that's why it disturbs you. Feel free to find large overlooked studies or federal-appointed commisions from any Industrialized nation which have chimed in on this to add (I left out australia, germany, japan, New Zealand,etc... because the point was pretty clear).

To quote another MD, you were "dumping". Again, I have no problem including other studies, but in an NPOV fashion - not a highlighted chart of ony those you selected. I will add back the other reviews or studies when I have a chance to discuss it with a reasonable editor -- not you. Until then, I will continue to edit your vandalism.

It is not powerful. You are picking and choosing your articles. You want this article to be an advertisement for breast implants. You can do that on your own website, which it appears you already have. You don't need to do it here.

2. The WAPO article is attached and the Inamed consultant and well-known acadedmic silicone expert is identified as such. Interestingly your sense of shouting out funding conflicts is diminshed when experts & studies are funded by vocal anti-silicone interest groups.

The WAPO article did NOT identify the INamed consultant as a "well-known academic silicone expert". YOU did that, because YOU wanted to highlight his credentials. It is not germane and not even in this article.

3. Your editing is a political crusade and you've admitted as such.

That is a flat lie. YOU are the one who accused me of that, and personally attacked me. I told you my academic background and interest as well as my personal experience. I am not on a crusade. You simply want an advertisement. It "ain't going to happen here" Oliver. I won't dignify you by calling you "Doctor". No medical doctor worth his salt would do what you are attempting here.

There is no attempt to present this in a mainstream NPOV by yourself. You've frequently either distorted and/or removed the best information we have to offer to patients from high-quality studies done around the workd by specialists in a number of fieldsDroliver 03:57, 10 April 2006 (UTC)

That is also a flat lie. The "best" information YOU have to offer is what YOU think will support your business. God I pity your patients.

I have restored the findings of the most recent research study that YOU don't want to admit exists. You completely deleted important findings. By the way, I didn't even do part of that summary of the findings, another MD did. But YOU don't like the findings so you simply erase them -- the very thing you accuse me of doing!

I have also restored the accurate summary of the study and the WAPO article. I am not removing the 'best information' as you call it. Your 'best information' is an advertisement for breast implants.

Your comments are flatly dishonest. I will be happy to include a summary of other studies, but not highlight a table with just pro-implant studies. You also are dishonest in saying that I am not including PARTIAL funding by a nonprofit group that argued to keep silicone implants off the market. At least the non-profit group was not financially conflicted as were the manufacturer shills. I included the partial study funding in the same paragraph as I included the conflict of interest of the manufacturer-associated chemists. You deleted the WAPO statement that SPECIFICALLY stated that the criticisms were from chemists associated with the manufacturers. THat is part of the article,whether you like it or not.

Once again, I will be happy to include other information when I have a chance to discuss it with a more reasonable editor - not you. It is not NPOV to highlight only one type of finding in a chart. A chart might be nice, but it needs to be NPOV.

Finally, you are the one that has a conflict of interest here, not I. You are the crusader, not I. You directly benefit financially from the approval and sale of silicone breast implants -- that is your business! However, I have to say that you are more dishonest about this than most plastic surgeons I have talked to. Your insistence on whitewashing this article is appalling.

Even your colleagues have been upset by your "dumping" in the article, deleting what you don't like, and, I might add, your poor spelling and grammar.

Edit war

Gee - calm down everyone please :-) As far as I can tell, no one has broken 3-reverts/24hour rule, but nor is a dispute over content "vandalism" (as I understand the strict use of the term). However this is clearly is a content & POV dispute. Aggressive editing (I'm trying to be positive here in my phrasing), by either side of any wikipedia dispute risks polarisation of the edits of the other. You both have useful edits/phrasing to include, but are both being over-protective of the opposing POVs (to a greater-or-less extent over a number of specific aspects of fact and article style).

Whilst we can all have views on how unbiased/neutral the FDA is (e.g. political "direction" influencing decisions re over the counter emergency contraception), it is difficult within an encyclopaedia to pick and choose those decisions we do/do not like and remain transparent in being NPOV. The FDA is "The" regulatory body for the US (and the British, now European, equivalent closely monitors & often follows suit), it is a fact that they (not the "anti-campaigners") withdrew the licenses and are being cautious about any reintroduction. Keeping aside for the moment issues of bias/conflict interest/statistical power of the various studies, there is de facto an official (FDA) concern. The article must therefore reflect this POV and that FDA previously and currently continues to have effect on product licensing (as of April 2006 the FDA has not given an unqualified green light to any & all breast implants). Against this, there are numerous opinions from researchers in several countries with individual studies (totalling several thousand women) and meta-analysis that dispute any risk, or the levels of risk, and this also needs be included. Yes there is a risk of manufacturers, and to a lesser extent plastic surgeons having a conflict of interest that might cloud their judgement as to the best interest of patients, equally one might claim that patients with problems might also be clouded (to some extent) that not every case can be as a result of their implant, as there is a natural background rate (of course it is the question of any additional rate, or its level, that is disputed). So is the article to remain NPOV by removing all accusations, or by qualified (? humble) inclusion of both POVs ?

Selective deleting of information (i.e. study details of one POV) is unhelpful as it tends to over-skew the article. Conversely adding volumous repetitive paragraphs on a POV results in a poor encyclopaedic style (i.e. fails to read as prose rather than a long list). Wikipedia is not a soap-box to carry out a debate, but rather to document the state of a debate in a NPOV. All editors should be able to contribute to a wikipedia article's discussion of both sides of a dispute in the real world. Do we really want to strip this section to the bare bones in order to reach a NPOV phrase, such as "Many researchers (some drug-company funded) have not reported any increase in rheumatological disorders, others including patient advocacy-groups have reported to the contrary and the most recent published opinion from the FDA was:...". If this is the only solution, then there is no need for any split of article as I suggested previously. However such drastic copyediting would be a shame, as there is more information (on both sides of the debate) that is worth commenting on. Yet this is not some PhD student’s university thesis paper discussing the full findings, statistics and pros & cons of every piece of research.

I thought a table would be useful to summarise like-info together - indeed if anything it somewhat diminishes the impact in the article of the many papers quoted – some are clearly highlighted as just meta-analysis/reviews rather than original research. The subsequent comments of the FDA stating its problems with past research was then more clearly apparent and more obviously directed at all the previous published material they had to consider. Putting long discussions criticising each paper for its conflicts of interest into each entry of the table would risk making the table unduly long and dominant in the article. Simpler and perhaps more effective would be a single sentence after the table quoting the FDA’s cocerns re author bias (full disclosure), number of patients and observation duration.

Personally I think the table (or else a short bulleted-list) should stay; it both added breadth of “pro” sources, yet also highlighted better the FDA criticism raised against them. I also tend to think that generally most author & journal names should remain out of the article text - that is the point of footnotes expanding on citation details. Adding the name of an author & journal of someone who promoted/criticised another, just because the other’s details are already included in the main text, seems to be equally poor editorial styling vs omitting both.

You have both contributed interesting information that I have enjoyed reading, but a more co-operative NPOV approach needs be taken. Do we wish for detailed info to be included in the article at all, vs the silly single-sentence I gave above ? If so, how should this be approached in the article ? May I suggest no further editing for a couple of days, but rather engagement only on this talk page for a bit ? Do we need to formally request for comments from the wider community (RfC); who I am sure will be greater sticklers for process and more formal in their approach to article development, than the current small team of contributors might informally discuss between themselves ?

If you both wish, I’m happy to help mediate or not to, if you think I’m unduly biased (I’ll certainly admit to being sad to see the loss of all the references having worked on the markup style). Otherwise should we call for RfC that I suspect will be partially supportive/critical of both editing approaches ? David Ruben ^Talk 13:59, 10 April 2006 (UTC)

Are you presuming that the only entries in a table are going to be those Oliver selected? Why don't you republish the table here, in discussion, where we can look at it again.

Also I take issue with your comment that there is bias w/mfg & "to a lesser extent plastic surgeons".... that is their business, and some are every bit as aggressive in lobbying as the manufacurers. The current editor here is a case in point. Funding needs to be made clear, as this is one of the major problems with many studies (see my discussion on your page about Mayo study).

above comment added by User:Jgwlaw 18:59, 10 April 2006

I would be a lot more open to Oliver's input if there were the remotest hint of neutrality. In fact, I have done some research on the platinum scientists, and I do think we should include the previous FDA finding. Contrary to what Oliver asserts, I do not think all the health problems women have are derived from implants. I also understand that some women think they are. We need scientists and doctors with open minds, to find out what what are the safety issues. I daresay if some of you had a ruptured silicone bag in your body and an onset of these health problems, you would also wonder. Rupture is a problem, and that is the main focus of my concern. Some doctors were bent out of joint because this first came up in court.

above comment added by User:Jgwlaw 19:54, 10 April 2006

David, I'm sorry as well that your table gets deleted by JGLAW. These studies are however representative of the general consensus on this topic and it's only come to the point of having to be so blunt about it as to have this giant table as her edits become more and more desperate. This whole thing was originally described in one sentence that in essence said there was general agreement from research that silicone was not implicated in connective tissue diseases. That should be enough to simmarize the debate for a superficial overview like wikipedia. You would think there was no good or credible research done in this area by the tone JGLAW wishes to put on the top of this. Plastic Surgeons have no financial stake in silicone implants per se (unless you're an Inamed/Mentor shareholder), there is no cost difference except a higher overhead for me with the silicone due to the extra paperwork and visits required. Those operations frequently take longer and are more difficult as well. Breast augmentaion is at historic levels with largely saline implants, and no one is speculating that some huge volume of patients is waiting for silicone to get their surgery.Droliver 22:15, 10 April 2006 (UTC)

I see that OLIVER is still making personal attacks. My edits are not desperate -Oliver wants to remove any findings that are not consistent with his view that silicone implants are perfectly safe. The table is not a bad idea, but we need to make sure the descriptions include the findings both positive and negative. Oliver did not do that. In fact, when I have edited some of those to represent the complete finding, he deleted it. If he is so damn sure that his precious implants are perfectly safe, he would not mind including the WHOLE finding, instead of merely selections from it. He would not delete the findings of the most recent platinum study. His first edits and writing looked like an advertisement for breast implants and tort "reform". (However I can understand why he hates med mal lawyers given his reckless disregard for potential dangers). However, he did finally acknowledged that his comments were not NPOV, after he spent days restoring his offending edits.

The fact is that there is not agreement that silicone is not implicated in connective tissue disease. The FDA points out that there is still a concern with the lack of long term studies, especially when rupture is involved. To date, it appears that some studies do not see a connection, particularly those that are short term or which remove women from the study if they have removed their implants. However, there are clearly studies that OLIVER doesn't want mentioned that show an increase in antibodies. Or, the FDA study that actually DID show an increase in connective tissue disease. Furthermore, there is a problem when Dow funds much of this research - good examples are the IRG & Danish studies.

Plastic surgeons most certainly do benefit from silicone implants being approved. For Oliver to say that is simply dishonest. It means more patients, since many women want silicone implants - That most certainly is projected, and I believe OLIVER knows this. I suspect that eventually silicone implants will be approved, and more women will become ill. At the very least, there needs to be clear informed consent, which is still not happening. Women are handed a booklet but told by many plastic surgeons that implants are "perfectly safe." I can see that OLIVER is probably one who does that. I wonder if OLIVER actually follows up with women with silicone implants, and for how long?

Does he remove ruptured implants, and see the gooey mess that there is? Does he see the pathology reports of silicone in various parts of the body? I doubt it. It doesn't appear that he gives a damn about women's health. He sees only what he wants to see, and deletes anything else.

• Ok that seemed more positive from both main editors (sorry Jgwlaw I was working on my reply for sometime and forgot to recheck the talk-page for current updates, causing an edit conflict with you. Its too late in UK now for me to rework the reply below, but I don't think anything immediately conflicts with the further points you kindly made - indeed I see you note some favourable changes to Oliver), although I'm not sure about the other recent lesser-editors and what their history with this article might be. But let me respond to the various points you both raised:
• Oliver, I think the collection of studies in the table is useful to indicate that there are a range of studies (both in number, country and of research type - meta-analysis, retrospective and follow-up). Equally though the table summarises down what was previously an excessively long series of paragraphs. See my comments below re types of research - would some pruning (for article brevity) of the meta-analysis papers be appropriate, leaving the primary studies ?
• The mark-up for citations has been poor, can I suggest that all editors wishing to add a source do so in the talk pages first so that:
  • other editors more familiar with wikipedia citation mark-up can do so fully
  • it can be discussed (both as to appropriateness of inclusion and context of inclusion), else it is likely to end up being deleted & reinserted if recent edit-tussling is anything to go by ?
• Jgwlaw, please sign your entries, aside from policy, it helps separate postings and gives a time/date that makes it easier to follow a discussion.
• No Jgwlaw, I don't presume only entries selected by Oliver should be in the table. There is a choice though as to how to structure any article, or section of it, that describes conflicting research and opinions:
  1. Pure time-line description, i.e. each study in its chronological order. Whilst this works best for the earlier part of the article discussing the history of how concerns first came to be raised, the FDA withdrawing product licenses and how we get to the current status, this is perhaps less helpful in more detailed discussion in the latter parts of the article that deals with specific (vs. overall) concerns. Here the general historical flow is less relevant than the scientific process of verifying any one result by repeated studies - so personally here I think collecting the lists for & against will editorially prove more concise.
  2. We could add a similar select choice of summarised "cons" research into this same table. That is not unreasonable. It would editorially make for a long single table, but would be "fair". However the FDA's remarks of 2005 re methodological problems with (the then) previous published studies then has to be qualified - is it against all studies included in our single table, or just those that reported absence of connective tissue disease risks ? Personally I found seeing a briefer summarised list of several researchers stating absence of identified problem with then a statement in the subsequent prose indicating the FDA stating statistical interpretation problems with everything they have looked at, seemed highly significant and thus appeared better emphasised in the article (but that’s just my impression on reading the article structure).
  3. Finally the selection of negative-effects research could also be summarised into its own distinct table (i.e. one table "pro" & one table "against"). Seems equally fair to me. If we opt for this and a table needs constructing, let me know here in the talk-page which items and comments to include and I'll happily mark-up the table for discussion & inclusion.
• I don't really have an absolute preference for either option (there are editorial style and article pro & con emphasis issues both ways with all 3 options). But I don't think any one option is purely favourable or unfavourable either way. The point of this talk page is to help reach consensus - so its up to everyone to decide which option (or any other) to choose or not choose.
• Equally, I don't think we can be totally inclusive of all studies (from either side) as the article will get to be just a long reference list, so some selectivity of the relevant research on either side is required.
  • Unless a meta-analysis generates a significant change in statistical power, I'm less in favour of including it than retrospective or follow-up-studies - but I'm not a good statistician to comment on "value" of the different papers previously quoted.
  • Just how inclusive or exclusive to be is an editorial decision - short succinct article that risks over simplification or substantive discussion that risks being too long for a general encyclopaedia - presumably the correct level is somewhere in-between.
  • If agreement can’t be found then the overriding wikiprinciple would be to force NPOV, the resulting simplistic single sentence is unlike to please anyone.
• As for degrees of conflict of interest, I tend to suppose the surgeons have a choice over saline/silicone and over which manufacturer to purchase from, whereas each manufacturer has only their own products to sell - but I am not familiar enough myself as to which manufacturer produces which product and how much choice a surgeon really has...
  • Are there really just 2 manufacturers involved, or is this just in the US with other smaller players involved elsewhere - I note someone else inserted a 'Worldview' tag warning to the top of this talk page, so am I missing something here ? (are there points here that need be added to the article ?)
• You both have other useful topics to add to this article – could you work on these for a while (regaining each other’s trust) whilst bilaterally ceasing to edit this contested section for a couple of days (irrespective of its current state), allowing the debate to cool ?
  • e.g. Oliver you mention longer operation times, did I read correctly that this is for silicone implants ? if so, then (i) why do they take longer ? (ii) does this in itself increase operative risks (i.e. from longer anaesthetic or greater post-op infection rates) (iii) would these disadvantages be sufficient alone to dissuade surgeons from returning to silicone even if in the future evidence/FDA gave a green light to silicone ?
  • A little more could be added to describe better the risks we can agree upon: post-op recovery, haematoma & immediate post-op infection rates.
  • I seem to recall last year there was much debate in the national media (in the UK) about teenagers having plastic surgery (breast or otherwise) and issues as to whether parents were responsible; either pushing for (to be successful actresses/models) or failing to guide against. It also lead to a brief return to the discussion of how young girls might be affected by "the media" to feel pressurised to the “body-perfect”. Should we mention this in the article, or should there be a quick redirection to such discussion on the plastic surgery page ?
  • Most BIs are for cosmetic reasons, where the "need" for surgery seems less (to me) than that in cases of reconstruction. But how is the need for reconstruction changing with perhaps greater use of limited lumpectomy for breast cancer (with subsequent chemo-/radio-therapy) vs. automatic total mastectomy in the past ? David Ruben ^Talk 01:26, 11 April 2006 (UTC)

I fear a table will be the entire article if every study is included in it, although we do need balance in any table. If you want a table of different countries research, it is necessary to provide the study or review's findings good and bad - whereas Oliver only provided those findings that were positive. That is my main complaint with the table.

It makes no sense to include the FDA in a table.

I doubt that anything would make me "trust" OLIVER at this point. I just don't think much of a surgeon who whitewashes the dangers of the surgery he performs. That is disturbing. As I pointed out, if he wants to advertise his wares, he can do so on his website - which he already has, from what I can see.

As to conflict of interest -- many women do not want saline implants, so the approval is most definitely a benefit to plastic surgeons. Saline implants do not look as natual as silicone implants. It is one of the reasons that plastic surgeons prefer silicone implants. I have no conflict of interest -- I do not benefit from the approval or disapproval of silicone implants. I do see the results of rupture every day, when I look at pathology reports. It should be, but obviously is not, disturbing to any plastic surgeon.Jgwlaw 02:56, 11 April 2006 (UTC)

• "It makes no sense to include the FDA in a table" - WTF? The commisioned panel reviews on these are important to show the context of a broad coalition of multinational agreement on this.
• All summaries and conclusions in David's table are verbatim re. systemic diseases in these large studies and reviews. Find ONE that is not. Any large contemporary or national review missing please submit. (You'll find EVERY countries proceeding has similar conclusions)
• You can quibble with any individual study using the anti-silicone activist talking points, but the volume of these papers has reinforced the conclusions on connections to connective tissue disease. Most people can look at this and discern that
• David, the operations for silicone implants are longer due to the extra disection and exposure required for their insertion. I'd guess this adds 5-10 minutes/side and turns a routine 30-45 minute procedure into a 40-60 minute procedure
• I'll repeat this again S-L-O-W-L-Y so Jglaw can understand. The winner with silicone implants are manufacturers whose margin is much higher on them. They only add to my overhead & decrease OR efficiency. Surgeons and patients prefer them because they look and perform better which is our "conflict of interests". In surveys of surgeons there is no indication that people are delaying augmentations waiting on silicone devices which Jglaw believes is some pending windfall. Augmentations are at historic #'s already.

Droliver 16:07, 11 April 2006 (UTC)

DOLIVER you have NO C-R-E-D-I-B-I-L-I-T-Y. Your deletions of the findings of the most recent study shows you bias. You can protest all you want, but I KNOW that plastic surgeons benefit - a good friend of mine is a plastic surgeon and we have had many discussions on this very issue. Thank God she is at least able to be honest in her explanation of the effects of silicone approval. Yes, augmentations are at historic levels, which is a tragedy. I won't delete the table, but you cannot delete other things which you have in the past.

You not only have no credibility, but you are insulting and obnoxious.Jgwlaw 23:15, 11 April 2006 (UTC)

DOLIVER did it again! He included a review of ANIMAL studies and a FEW CASE studies -- after he chastised me for including case reports and not studies. Amazing. Or not so amazing. THIS WILL NOT BE IN THE ARTICLE. There was also no citation for that "review" (I wonder why). I looked it up and found that "one series of patients examined showed a significantly higher prevalence of the disease than expected". Interesting that Doliver did not include this. Regardless, this is way too limited as the report itself states! If DOLIVER insists on including this, then I will take it to an independent review. Jgwlaw 23:15, 11 April 2006 (UTC)

DOLIVER - IT IS A DUPLICATION (not a replication)!!! If you read the damn studies you will see this. The "National Panel" is the same that was used in the other study. IN fact, the same quote. The panel review was clearly done before it was published in 2001 because it is the same study exactly as that discussed in the US district court review. You CANNOT include that twice. I REFUSE to allow it.Jgwlaw 00:12, 12 April 2006 (UTC)

DOLIVER: Hopefully we can agree on the Spanish review, since I quoted it verbatim. What you selected was EXACTLY the type of thing you criticized me for doing (again). It was not from the summary. I can't believe this is your idea of "balanced". What is not okay for me to do is acceptable for you to do. That's not the way life works Oliver. Well, maybe it is the way YOU work.

Also, why don't you log in and not edit anonymously? I know it is you, so why don't you log in? Are your edits so clearly prejudiced that you don't want to be identified? Jgwlaw 00:37, 12 April 2006 (UTC)

OLIVER -- YES I READ THE REPORT AND THE PAGE YOU CITED. IT HAS ONLY THE PARAGRAPH I INCLUDED. YOUR QUOTE IS NOT IN THE SUMMARY. FURTHERMORE THE IAEG STUDY DOES NOT STAY. I WILL CONTINUE TAKING IT OUT BECAUSE IT DOES THE VERY THING THAT IS IN A STUDY I INCLUDED THAT YOU DELETED. It is not just small, it is based on animal studies and case reports. That does not qualify for inclusion. Period.Jgwlaw 00:48, 12 April 2006 (UTC)

I also corrected (without objection) the referance of a request by a US district court. This is one of the many lowest federal courts and hardly is "the Federal Judiciary".Jgwlaw 01:21, 12 April 2006 (UTC)

WRONG CITATION -- The citation for the first entry in the chart (IOM) is incorrect. This article discusses cancer, not rheumatological issues. Please correct.Jgwlaw 01:26, 12 April 2006 (UTC)

• I had tried to make some wikimarkup edits but got constantly blocked by edit-conflicts from both editors' repeated editing/reverts - at over 6 each for the Rheumatology section, I've sadly reported you both for WP:3RR violation.
• You both have good information to add to the article, although I think both your contributions tend to be too lengthy and in need of greater summarisation for what is meant to be a general encyclopedia.
• Implant-supportive data is interesting, but equally undeniable is the FDA's continuing concerns and the continuing ban on silicone implants. The NPOV is somewhere inbetween the edits - having read some of the material/research cited I am more concerned that I previous wasn't. I think overall the article is probably about right in its overall objective concerned stance (each time I read one of the many many edit versions I find myself swinging from feeling its POV over-for or over-against, so really never been able to form a steady opinion over a stable article).
• I've tried to assume good faith of all editors and engage positively with some aspect or other of their POVs. However I've probably engaged as much as I can for now, and as previously remarked upon to try and help sort out this dispute, I've made a Wikipedia:Request for Comment.
  • May I suggest editing stops for today, whilst the situation calms and other editors from the wider wiki community have a look at this article to try and assist :-) David Ruben ^Talk 02:36, 12 April 2006 (UTC)

David, I'm 100% fine with other editor's looking at this. If you will notice the difference b/w what I'm doing (or feel like I'm doing) which has been refining (adding links to direct text) the table you made with the major health ministry reviews (US and abroad) and largest series. Our resident expert has decided that 1)the initial 2 UK reviews are irrelevent, 2)the French ANDEM review is irrelevent, 3) that two of the major US reviews (by different authors in different journals) are in fact only one study, 4)every study cited is compromised by her percieved conflicts of interests, 5)the Mayo clinic study is wrong because "my neurologist said so",6)in abscence of evidence she likes........delete,delete,delete. Essentially I've spent my time editing today restoring what she deletes, trying to address her complaints re. citations,links etc... and inviting her to add ANY relavent work to this. I welcome sanity here watching the ridiculous pace of loopy revisionism. (It's like when Brad Pitt & Morgan Freeman see the psycho journals in "Seven" with deranged writings goin on & on in all directions) Droliver 04:10, 12 April 2006 (UTC)

Responses to request for comment

I'm by no far cry an expert on this subject, but following David's RfC I had a look over this article. I feel that the contributions made by both users are indeed relevent, and should in some way be included. However, this article is becoming quite lengthy and if the table is included, it will (in my view) reduce the readability further. I suggest that the article should be split, as proposed above, into an article which deals will both sides of the issue (which I don't feel was covered in the table). Perhaps the new article could be further split to include more specific facts pertaining to auto-immune diseases, including the table.

One thing I strongly recommend is that both Droliver and Jgwlaw, when the 3RR block expires, should reach consensus before any further changes are made to this article. Further edits aren't going to solve this, and will simply result in further blocks. I must also applaud David Ruben for his patience and mediation in this situation. Scot^t 18:59, 12 April 2006 (UTC)


Judging by the section above, both User:Jgwlaw and User:Droliver would be well advised to read and follow Wikipedia:Civility. Jgwlaw, if you have not already started doing so, please sign and date your posts to talk pages, unless you have some excellent reasons not to do so. If you have started doing this, thanks!

Can I just be clear on what the two participants in this edit war are looking for? Looking at the recent diffs, I assume this diff represents the differences - that is, Jgwlaw believes the table should be this one while Droliver believes the table should look like this. Is this right? Is this what the argument is about? Mike1024 (t/c) 00:01, 13 April 2006 (UTC)

If that is the locus of this dispute, I think that the tables could be summarised in a paragraph, pro and con, and then both linked to in a daughter article (BTW, the tables are lovely, David, and good work mediating). IronDuke 01:19, 14 April 2006 (UTC)

What I added to the tables was the full finding - both the findings that were supportive of implants, and the concerns. That did not go over well. I also asked that Oliver provide a citation for a study and a conclusion (not just 'same as above'). I did not delete it because it was 'irrelevant' as he alleged. There have been studies funded by Dow Corning that are very supportive of implants. Even in (most) of those studies, there have been concerns cited. Surely those should be included. As to a 'pro' and 'con' - a complete description of a study's findings would be sufficient; eg do not leave out that which one party does not like. Also, do not include duplicative reviews of the same studies. molly bloom is jgwlaw molly bloom 21:34, 14 April 2006 (UTC)

Can anyone tell me where to find information on how to format? I tried to italicize and obviously was not successful.molly bloom 18:28, 15 April 2006 (UTC)

You can find a detailed guide here. For italics, 2 apostrophes: ''content'' --Scot^t 19:18, 15 April 2006 (UTC)

Thanks!!molly bloom 19:43, 15 April 2006 (UTC)

risk/controversy section

I propose a signifigant consolidation of the controversial area of this entry. I've refrained from restoring what I feel is the proper context for this to play nice, but we're left with a disjointed and rambling entry that isn't reflective of most of the literature. What is stretched out over multiple paragraphs is easily summarized in several sentences with attached references for those wishing to examine the various reviews and articles. I would like some 3rd party participation to act as the editors here. Droliver 15:22, 17 April 2006 (UTC)

Risks & Controversy Section

The article on BI needs to be balanced. That means one section is not expanded at the expense of another. I am glad the previous editor 'refrained' from further POV comments. However, this time the edit was done in another section - local complications. The section on 'local complications' was simply collapsed into one disjointed sentence. The complication of necrosis was entirely deleted, which rendered the photo meaningless. Yet another section describing types of implants was expanded and a chart added, which was merely redundant. This is a detailed article, but it needs to be NPOV. Expanding one section while deleting one that does not serve the editor's purpose, is POV. It is my understanding that anyone is free to edit Wikopedia -- interested parties, researchers, experts of various types and even doctors. Finally, Dr. Henry Jenny was the first to develop saline implants. I have included references to this, and I will cite them in the 'proper format' as soon as I can figure out how to do this. I am still new to Wiki. molly bloom 21:24, 17 April 2006 (UTC)

RESTORING

First and above all, before some 'monitor' (he is not an administrator) starts crtiticizing an editor and making implicit threats, it would be helpful if he would read what he is 'reverting'. In this case, he clearly did not. Also, to editors: please reference with citations that actually support what is written. I have noticed a number of alleged references that have nothing to do with the edit being made. One such statement was the erroneous comment about the inventor of saline implants. I changed that statement, and provided a citation that relates directly to my edit. Also, before someone starts making wholesale changes, please discuss here. I think that is a reasonable request. The complications page should stay as it is now. This is a complete list of the local complications, which are not in any dispute at all, and should stay. The photo I included directly references this list. There is no more need to 'summarize' this than there is a need to shorten the type of implants or techniques used. To collapse it to a disjointed sentence while leaving or expanding with redundancies is POV.molly bloom 00:34, 18 April 2006 (UTC)

1.In re. to the saline device: This is cited in the reference you deleted as well in the recently published 2006 Mathes Plastic Surgery series Vol 6 pg 2, quoting "The inflatable saline-filled implant was first reported by Arion in France in 1965. The impetus for its development was to allow smaller incisions through which a non-inflatable device could be inserted and then inflated with its liquid filler material". Dr. Jenny was involved in later incarnations in the 1970's. See also similar citations on the web[2], [3],[4]

Droliver 01:41, 18 April 2006 (UTC)

Your original citation said nothing about the invention of saline implants. However, I looked up what you had here, and there is indeed a reference. This is most interesting and I have done more research. It appears that the New York Times article misstated facts, as did some articles that claimed only that Arion was the first reported inventor of saline implants.

I have read a number of academic articles now on this, and am still not entirely sure. In fact, there are contradictory statements. So it may not be you or I at 'fault' here. Because of this, I have asked a plastic surgeon whom I know to be an expert in this field. He has many many years of experience, and is quoted in a number of academic articles. I incorporated what you wrote and what I wrote, and it may still not be correct. Let's wait until we get input on this from some more renowned experts.molly bloom 03:29, 18 April 2006 (UTC)

I have restored a little of what I previously wrote that Droliver deleted, but most of my changes were intended to simplify the language. This article should not use medical jargon. It should be aimed at a lay audience.

Since there seems to be concern about the length, I took out the section on techniques, which seemsd to be aimed at plastic surgeons. It is much too technical, and other articles on medical procedures don't include that kind of information.

There are too many references that are not linked to text, but rather than start an editing war I just removed the oldest, weakest studies. What remains are most (but not all) of the government funded studies and many studies funded by Dow Corning or plastic surgery societies. I will try to link some of the studies to text when I have more time.

Any citations of FDA analyses of Inamed or Mentor Corp research is available on the FDA website, www.fda.gov. Unfortunately, the implant makers have never published it. Drzuckerman Dr Zuckerman

Too long and beyond encyclopaedic

One benefit of splitting it up is that you can layer the infroamtion - presenting first what people who ask the encyclopaedia "what is a breast implant" with a small amount of useful information, and then rather more detail to those who are considering whether they are a good thing, or whether public discussion of them is credible. The level of infromation being argued over recently seems more that of a product insert, which is prbably better left to product inserts, IE by reference ratehr than even linking in WP. As far as complications of plastic/implant/augmentative/cosmetic surgery go, which is a superset of compliations of surgery, both of those would be better handled by articls just on them, which might be briefly referenced from anywhere. I note that WP is not a hierarchical collection of information, but it does not make for a readable article to have such information in such quantity. The article could do with more focus on why, rather than the minutiae of what. Midgley 04:01, 18 April 2006 (UTC)

bad layout of list, and mammography twice

" 12. Interference with Mammography'

Interference with mammography due to breast implants may delay or hinder the early detection of breast cancer. Implants increase the difficulty of both taking and reading mammograms. Mammography requires breast compression (hard pressure) that could contribute to implant rupture.

" There are ways to wikify that list, but mammography shouldn't be in it... the complication if it is one is "delayed recognition" not "interference with", and the following section covers mammography. The whole list is excessive detail at that point. Midgley 04:12, 18 April 2006 (UTC)

Edit-war again ?

(Edit conflicts with Midgley - sorry, but too late for we to totally rework this response - we're both highlighting similar problems with the article at the same time, but I include below a wider point about editing behaviour in this content dispute). Hooray - at last some dialogue in talk pages without prior edits to the article - I was considering referring this edit war for further administrator action, but shall continue to observe for another day or two. I had avoided making any significant changes to Breast Implants or this talk page until the recent blocks on 2 editors expired. I had hoped to then help the various editors engage in some discussion over editing (I'm still willing to help mediate). Unfortunately the article has returned to an edit war with some 53 edits in the last 24hours alone - quite ridiculous.

Please note the comments of the RfC above, it is generally sensible for editors involved with a contested article to engage in talk-page discussion and consensus agreement prior to making further edits to the article itself, which may just inflame an edit-war further.

As is present at the bottom of the wikipedia window "If you don't want your writing to be edited mercilessly or redistributed by others, do not submit it.", so editors need to be relaxed about their contributions and their interaction with other editors. Wikipedia is an encyclopaedia, and as such summarises information. If another editor decides to change one’s own contributions then one should seriously give thought before reverting back to a previous version, if a re-revert occurs then doubly so. Many editors in this situation do not continually revert until limited by the Three Revert Rule, but rather choose to follow a One Revert Rule. This means that if one’s edit is reverted, then rather than immediately revert back one instead initiates discussion on the talk page. Wikipedia has no deadline for completion, so there is no hurry to "correct" an article - if it is a great article in one month’s time it is immaterial if it reaches that stage in a day, a week or 29 days. Likewise there is not hurry to complete discussion over a point - allow the other editor time to respond and also allow time for other editors to contribute, thus allowing a consensus to form (so don't post a talk-page message and then edit article a few minutes or hours later).

Currently the article is in a poor state (I'm not referring to any one edit version here) - it lacks clear progressive expansion of information, is too long (too verbose), and is repetitive & duplicates. It needs rewriting, better summarisation or splitting (but there was not consensus for the later recently) - I note Midgely's comments above. As an example, the complications list. I don't think any editor is disputing any of the items included, in so far as whether they occur or not, but there is a styling issue within an encyclopaedia - namely do they need mentioning in each and every article on surgical procedures ? Complications should be included if peculiar to a particular procedure (i.e. implant rupture clearly pertinent to BIs), or if risks especially high (e.g. risk of death in emergency aortic aneurysm repair compared to planned procedure), but any operation can cause pain, bleeding, infection, scaring. This article on BI is not attempting (I hope) to list every possible complication - if so, then it needs be quadrupled the length to also include risks of anaesthesia, analgesia medication given, intubation, prolonged immobility causing DVTs etc etc etc. So what we currently have is a selective list, and the question is what criteria are to be used as to those we include ? To mention at length complications that are not unduly specific to this procedure, may be viewed as a general POV push at discrediting. Yet the article already mentions clearly the FDA's concerns and banning of the products, so care needs be taken not to "over play" a position.

The summary paragraph seemed a better editorial choice, problems with the current list being:

• Pain- is this particularly severe compared to other surgical operations, or is persisting chronic pain any more likely ? If not, then this does not deserve a whole paragraph.
• Infection - the current version notes "Most infections appear within a few days to weeks", so is this any different from other operations, particularly those involving foreign body insertion (e.g. pins, screws & plates in orthopaedic surgery, dacron tubes used in artery bypassing, intra-ocular lenses in cataract removal) ? Again if not peculiarly special to BI, then needs only brief mentioning.
• Haematomas - again special to or peculiar in BI's ?
• Interference with mammography - this is duplication, as a whole section is already devoted to this.

The article probably reads better for the absence of the list of BI-supportive studies re Rheumatological disorders, by which I mean that it was heavy going reading through the multiple paragraphs, and another user has commented that my attempt at summarisation into a table did not seems that great a summarisation/reduction. However, the current version cites none of the studies. To have "A number of existing studies internationally" seems a little skewed given the large number of entries the table included at various points. I'm not insisting on the data/table re-introduction (I'm just one editor and consensus applies), but at least a few of the studies should be cited at this point at least (i.e. footnote references, not necessarily description in the text). David Ruben ^Talk 04:17, 18 April 2006 (UTC)

Point taken about the length of the list of local complications. I object to reducing it to one sentence, however. Necrosis is a serious complication with breast implants. While not unique to implants, hematoma/seroma is too often a complication with implants and can cause contracture which is unique to implants. Also important is the shifting/undesirable outcome, and loss of nipple sensation (which is very common and a real problem for many women). I have shortened this section considerably. However, it is not valid to say this highlights already discussed issues re the banning of silicone implants. The banning of silicone implants was not because of local complications. Local complications are simply a fact with implants and should be discussed, more than one sentence. Hopefully what I have edited now will eliminate redundancies and normal complications of any surgery (that do not cause other problems unique to implants.)molly bloom 06:07, 18 April 2006 (UTC)

The 'chart' that was introduced in 'generations of implants' was redundant, since the text already discussed this. Also, I do not think that the 'generations' of implants is correct. A plastic surgeon I consulted tonight agreed, and he said he would help edit that section. I left it as Oliver had it (with the exception of a chart that was redundant). molly bloom 05:40, 18 April 2006 (UTC)

I agree that some of the other studies need to be included. I am not sure it even should be a footnote. There could be a sentence or a paragraph, with footnotes. The chart had many entries because many of those were reviews of the same studies. As another editor observed, this is not appropriate. molly bloom 05:49, 18 April 2006 (UTC)

I have not changed that, because I knew it would start yet another edit war. I welcome another editor's suggestion - preferably here in discussion first, since it was so contentious. Perhaps the plastic surgeon I talked with tonight might be amenable to helping in this area.molly bloom 06:14, 18 April 2006 (UTC)

My goal has never been to show only one side. I do not want the article to read like an advertisement for breast implants, which it did originally.molly bloom 06:14, 18 April 2006 (UTC)

Last picture edit

I removed the last picture added because the article already seems to have pics of women who have had breast augmentation, and that picture (and the caption under it which was a bit too titillating vfor an encyclopedia) added nothing new other than a picture of another woman with large breasts. Pat Payne 21:05, 19 April 2006 (UTC)

Good move, Pat. I wonder if there is really a need for any photo of a 'woman with breast implants'.

Don't you think people know what women with breast implants look like?molly bloom 21:41, 19 April 2006 (UTC)

Probably not, but I was giving the other one the benefit of the doubt because it was clearly a clinical "after" photo, and didn't look like it had been ripped from a fetish mag. But you're right, having a picture of a bare-chested woman, especially if you can;t verify that the woman in question has had augmentation is a bit needless to the topic. Pat Payne 14:55, 20 April 2006 (UTC)

I'm not allergic to breasts, but I would like such illustrations to serve some instructional purpose here. It would be nice if we had a before & after set, to show the effects of such surgery. Alienus 17:26, 20 April 2006 (UTC)

I'm not allergic to breasts either and I agree illustrations should serve some instructional purpose. I just don't think before and after sets serve an instructional purpose. Anyone with eyes knows the difference between large and small breasts. It doesn't illustrate anything we don't already know. A before and after set would merely be advertising for the plastic surgeon industry and/or titillation and there is already plenty of that on the web already. Gfwesq 02:32, 21 April 2006 (UTC)gfwesq

I disagree. It's not the same as the difference between "large and small breasts". Breast implants - at least, the more common, less expensive ones - have a very distinctive shape which is pretty easy to distinguish from real breasts. (The more expensive ones used by more wealthy clients are much harder to distinguish.) This is notable because it speaks to the fact that implants are generally not as well-concealed as their makers and owners would prefer. For instance, after trawling through the page history, I see nothing titillating at all about this image, which was formerly included in the article. It is presented in unflattering lighting from a simple frontal angle, there are no sexual paraphernalia or costumes or lingerie, there are no suggestive looks, there are no sexual activities taking place in the photo, there isn't even a background, and the genitals are not visible. There is nothing in the image but a female torso with false breasts. It serves to illustrate the subject matter of the article. If people think that image is titillating, then it would be literally impossible to find a photo of implants that wasn't "titillating", unless it were a photo of implants on a cadaver. Removing notable images on a subjective decision that they're "titillating" simply doesn't hold water. Respectfully, Kasreyn 06:20, 25 May 2006 (UTC)

I am glad the photo is off. There is nothing notable about that photo. Nothing. And, besides that, we dont' even know for sure if it is legitimate. It really IS the difference between small and large breasts.MollyBloom 01:07, 31 May 2006 (UTC)

Breast implant: editing conventions, important conduct policies, and a proposal for progress.

The following pertains to the recent activity of two contributors to this article, and contains some suggestions for improving both the text and the editing environment. I make these remarks in the hope that the ongoing troubles over this article will be addressed in a spirit of cooperation and mutual respect.

On April 12th, 2006 I temporarily blocked the accounts Droliver (talk · contribs) and Jgwlaw (talk · contribs) and the IP 65.89.98.20 (talk · contribs) for their involvement in an 'edit war' over this article. User:Droliver has edited from the IP 65.89.98.20; I believe, but am not certain, that User:Jgwlaw edits from the IP 67.35.126.14 (talk · contribs). In neither case have the IPs been employed to circumvent or infringe Wikipedia editing policies; I will therefore make little reference to them in what follows.

'Revert warring' is a practice that is especially frowned upon in Wikipedia. It goes against the collaborative spirit central to the project, and suggests a disinclination on the part of involved editors to discuss their differences of opinion respectfully on the Talk page. Although it may seem unlikely, most content disputes can be brought to a satisfactory resolution; the critical ingredient is sincere, thoughtful discussion amongst involved parties with the goal of producing a fair, neutral and informative article. This cannot occur if a revert war is going on—it is the Wiki equivalent of yelling at each other. Furthermore, aggressive revert wars make it difficult for people to read the article: the text keeps changing very rapidly, often with large chunks appearing and disappearing in quick succession. This can also make it impossible for other editors to contribute to the article. The following series of reverts (edit summaries in italics) occured over just two days at Breast implant.

Reverts to Breast implant, 23:04, 2006 April 11—04:09, 2006 April 12

by Jgwlaw (talk · contribs)

• 23:04, 2006 April 11 rv redundancy
• 23:10, 2006 April 11 Rv limited case studies of scleroderma -one 'series' showed an INCREASE
• 00:00, 2006 April 12 Exact study reported twice. Not a valid representation
• 00:09, 2006 April 12 Deleted AGAIN a report that was based on animal study and few case reports
• 00:25, 2006 April 12 DOLIVER you need to cite this and write the conclusion. The review you referred to it will not be included
• 00:25, 2006 April 12 DOLIVER you need to cite this and write the conclusion. The review you referred to it will not be included
• 00:46, 2006 April 12 This is not about policy findings; IEAG DOES NOT STAY
• 01:11, 2006 April 12 Did you ever take math? Consider it a 'subset' of the larger set. The National Panel review was quoted (exact quote) in the earlier publication
• 01:13, 2006 April 12 IAEG DOES NOT STAY for same reasons my earier reviews did not stay. It will continue to be removed
• 03:12, 2006 April 12 rv duplication and merge with table
• 04:09, 2006 April 12 We will leave it to the arbitrators - it has been referred

by IP 65.89.98.20 (talk · contribs)/Droliver (talk · contribs)

• 17:33, 2006 April 11 discuss any percieved distortions in summaries on the discussion page, but preferably add studies/panels rather then delete ¹
• 23:44, 2006 April 11 IEAG was the first of the major reviews to come in after the Dow suits
• 00:04, 2006 April 12 This study is not replicated in the table, please explain?
• 00:22, 2006 April 12
• 00:25, 2006 April 12
• 00:26, 2006 April 12 Again, read the sumary conclusions of the Spanish review
• 00:41, 2006 April 12 IEAG report linked
• 00:55, 2006 April 12 IAEG was the first major review. What about that do you not understand?
• 00:58, 2006 April 12 These are 2 seperate reviews by different authors in differernt journals
• 03:47, 2006 April 12

  ¹ [Note: This is technically not a revert, as in this edit Droliver introduces to the article a table of studies pertaining to the subject. The text here had been incrementally reverted over April 9-10; with this edit the 'revert war' of April 11-12 began].

Reverts to Breast implant, 04:43, 2006 April 9—23:50, 2006 April 10

by Jgwlaw (talk · contribs)

• 04:43, 2006 April 9 If you can't cite the whole conclusions, then none stays.
• 04:45, 2006 April 9 Studies not completely described; delete
• 04:50, 2006 April 9 You can't choose what funding you want to cite. You can't deceive by incompletely described studies
• 04:58, 2006 April 9 delete old Mayo & Dow funded study
• 05:03, 2006 April 9 Cancer study a wash; not relevant then, if true
• 18:33, 2006 April 9 a table only of selected 'studies' is not NPOV
• 06:52, 2006 April 10 Oliver MUST stop deleting valid description of latest research
• 23:50, 2006 April 10 Please see discussion

by Droliver (talk · contribs)

• 14:28, 2006 April 9 Disingenuous whitewashing reverted back
• 18:17, 2006 April 9
• 03:10, 2006 April 10 major studies and review table restored
• 03:25, 2006 April 10
• 21:55, 2006 April 10 Is the factual accuracy of this table in dispute? attached links should enable verification, no?

Please do not do this again. It is not productive, as must be apparent by now. As both of you, Droliver and Jgwlaw, are very new, I do not for a moment doubt that you had good intentions but were not familiar with the editing norms of Wikipedia. I trust that henceforth you will not edit in this manner. Please read very carefully Wikipedia:Revert only when necessary and Wikipedia:Three-revert rule.

I would like to make a few suggestions concerning your editing activity in Wikipedia.

Some important editing conventions

• When posting a message on any talk page (i.e., the discussion page of an article or a Wikiproject page or an editor's userpage), it is customary to sign and date your posts. This is done by typing four tildes at the end of your posts, like so: ~~~~.
• When replying to another's post, make sure to properly indent yours. Please read Wikipedia:How to edit a page, in particular the Wiki markup section. If your reply contains paragraphs, you will accordingly have to indent each paragraph with the same number of colons/asterisks.
• Please do not ever delete another editor's comments or alter them. If you are concerned about incivility or personal attacks, politely point out precisely what you find objectionable and ask the other editor to cease making those remarks. If the behavior continues, report it to an administrator (Wikipedia:Administrator's noticeboard).

Important conduct rules

• Wikipedia is inherently a very forgiving place. Newbies are warmly welcomed and encouraged to edit full articles from the get go. Indeed, it is thought that one of the better things about creating a reference work via the wiki process is that mistakes are continually corrected; editors are told not to be afraid to write, edit and modify. If you make a mistake, it is easily undone. If you do not know how to use a complicated template, that's fine—ask for help or even just give it a shot and see; if it doesn't work a hundred more experienced editors will gladly come to your aid, with a smile. If you do not know how to reference an article like David Ruben, no worries—put your reference next to the text you're writing, or leave on the talk page, or ask someone who's been around a bit longer: we're all glad to help (and if you make a mistake, we'll be glad to clean it up too). If you can't write prose like a seasoned Brittanica editor, that's no problem either: some day someone will improve it for you.

  But there are some things Wikipedians have rather less tolerance for. We do not take sustained incivility, baseless assumptions of bad faith, and personal attacks lightly. Virtually all editors who have been brought before the Arbitration Committee and permanently banned were folks who did not quite get this (or who got it and sadly didn't care). Please know that on Wikipedia, we value politeness, we value those who write thoughtfully even when they disagree with those to whom they write, we value those who do not return incivility with more incivility, we value those who work to raise the level of discourse, we value those who always try to see the best in others and politely help them where they falter, we value grace and temperance, we value the forgiving smile over the biting retort.

  Over the course of editing this article both of you have been rather less civil than I'm sure you usually are; much of this can be attributed to your newness to the project and the very human habit of losing one's temper.This is understandable. But now, I'd really like both of you to shake hands, put this behind you, and work together like the great folks I know you are. You both mean well; what's happening is that you each place a different level of importance on different aspects of breast implants. But it is resolvable—a good article is in the making, if we give it the chance.

  I would like both of you to read the following:

• Wikipedia:Civility
• Wikipedia:No personal attacks
• Wikipedia:Assume good faith (of particular relevance and importance here)
• Wikipedia:Staying cool when the editing gets hot
• Wikipedia:No angry mastodons

• A very good rule of thumb is: Comment on content, not on the contributor. Do not comment on the other person's intelligence, competence, or motivations (e.g., do not assume that the other person is writing with an agenda to turn the piece into anti-implant propaganda, or can only speak as a patient who has had a poor personal experience with implants, or is a conniving surgeon who can't wait to get greedy hands on FDA-approved silicone implants). No personal remarks, please; no insinuations on other editors' talk pages about how awful so-and-so is. This approach is completely antithetical to the collaborative spirit of Wikipedia. If you disagree with an edit, politely state why you think it is suboptimal, and try to work out a fair solution.

The article

• Finally, some thoughts on the article itself. The major dispute over the controversial issue of implant risks seems to have distracted editors somewhat from the rest of the article.
  1. The lead section can be greatly improved. Wikipedia:Lead section provides the basic details of how to write a good lead. Essentially, the lead section must be a clear, uncluttered, well-written summary of the rest of the article. (Medical professionals will recognize the obvious analogy to the abstract of a paper). It must touch upon each major theme that is addressed in greater detail in the full article. Here however the lead section is just two sentences long. For examples of a good lead section, see Evolution (which incidentally is an excellent example of how a subject with controversial aspects can nevertheless be well-written), Barbara McClintock, S. A. Andrée's Arctic balloon expedition of 1897 (which, despite the quaint title, is an outstanding example of an encyclopedia entry, written in the main by one of Wikipedia's finest editors), and Military history of France, among many others.
  2. This entry is about breast implants. An encyclopedia article on this subject should clearly (and neutrally) address the following topics: What is a breast implant? What are they made of and how are they made? How widely are they used (and related epidemiologic issues)? What is their history? What problems are they used for? How do doctors decide on good candidates for implants? What preparations/tests must a patient undergo before surgery? What are the available operative approaches and techniques? What are the outcomes like? What are the risks of implant placement? How are complications managed? What is the controversy over implants about, what happened, who were/are the parties involved, what is the status now? Because of the dispute over one (albeit important) aspect of the article, other aspects appear not to have received the attention they deserve.

     The issue about the controversy also appears to have distorted other sections. Under the heading Types of implants, which begins just two sentences from the start of the article, we have a paragraph that states, quite suddenly, that "The General and Plastic Surgery advisory panel recommended FDA approval of Mentor and against Inamed silicone gel breast implants. Despite the panel's recommendation that Inamed's implants not be approved, the FDA sent Inamed a letter..." Why is this here? The reader has been given no indication of what Inamed and Mentor are, the silicone implant controversy has not been alluded to prior to this, and the average reader will be quite puzzled with this segment. It is also in the wrong place: a section on types of implants should spend three or four well-referenced neutral paragraphs explaining the types of implants. There is a place for the above information, but it is not in the middle of this section—an encyclopedia article must be clearly structured. We should not allow enthusiasm for presenting important details about one issue overwhelm other aspects of the article. As Wikipedia editors, our primary concern should be to craft a balanced, neutral, informative, clear, well-referenced article: we should be dissatisfied if the article is not balanced, even if in favor of our personal points-of-view.

  3. The chief problem here appears to be the risks and controversies section. Now, it is important to be clear about this. That many risks are associated with implant surgery is uncontroversial. Like all major surgical procedures, implant surgery can be complicated by anesthetic mishap, infection, bleeding/thrombosis, local neurologic sequelae. Peculiar to breast implant surgery, there is also the risk of implant rupture/leak and capsular contracture. Aside from these known risks, there are also attendent problems such as interference with mammography, calcium deposition in the surrounding tissue, and post-surgical movement of the implant which may cause a poor cosmetic outcome. None of this stuff is controversial, and a good article will address them in plain, neutral language. Four or so well-referenced paragraphs mentioning all these things at the level of detail expected in a general article about implants, in a general encyclopedia, should suffice.

     The controversial bit is whether implants can also cause chronic systemic diseases and autoimmune disorders. The available evidence overwhelmingly suggests that the answer is no (at least with respect to known disorders); there is concern however that the available evidence is not good enough. It should be possible to write one fair, neutral paragraph that summarizes the controversy, always bearing in mind that here on Wikipedia, we do not take sides—we write about the controversy from a neutral point of view. (An aside: it has been said that when a good Wikipedia editor writes on a controversial topic, you should not be able to tell from his writing or comments which side of the issue he personally advocates. That is the standard of neutrality I would like all editors participating here to aim for).

     Now, there is no doubt that the specific subject, silicone breast implant controversy, can be written about at great length: it has a long and involved history, and thousands of pages have been written devoted to it—books, journal reports, court documents, company reports, news reports. It would be inappropriate, however, to reproduce a voluminous account on a general article about breast (including saline) implants, especially at the expense of the other important aspects an article on breast implants should contain as mentioned in 2. On the other hand, the controversy and its history are important, and it is desirable for an encyclopedia to have a good account of it. So what do we do? On Wikipedia this type of problem is resolved by using something known as the Summary style. I urge those of you who haven't read this document to do so. (This should not be confused with a POV fork. A POV fork is a second article on a given subject with an opposing POV; i.e., instead of collaborating to write a single balanced, neutral, article, editors of opposing points-of-view create two biased accounts of the same topic. The impetus to create silicone breast implant controversy however is that this subtopic is sufficiently noteworthy, important and complex that it requires an individual page, itself conforming to NPOV, which the main article breast implant will summarise in a neutral fashion in the relevant subsection).

  4. One more problem with the article is that it is too U.S.-centric. This is a bias many of us Wikipedians have to work at overcoming. Wikipedia is a general encyclopedia with a global audience; indeed, given population and developmental trends, before long the majority of the web's audience will be non-western. When writing articles, always remember the diversity of the audience: it might be a good idea for most of us to picture ourselves trying to explain what breast implants are to a young female college student in China or India. Or even better, perhaps, to a Martian. Should we really write 'FDA' in the second section (nowhere in the entire article is it written 'U.S. Food and Drug Administration')? Should we nonchalantly write "According to a Congressional report..."? Should we only write about surgical practice in the US? Shouldn't we also mention incidence figures from elsewhere (where available)? And so on.
  5. In view of the preceding, I suggest the following:
     • We need to work on a general clean up of the article, from the top down. I suggest the following structure:

       Lead section (untitled by convention)

       Types of implant

       1. Early forms of breast implant
       2. Silicone implants
       3. Saline implants

       Patient evaluation

       Surgical techniques

       Risks and complications

       1. Known risks and complications
       2. Possible risks (can anyone think of a more neutral section title? Should also link to main article See also Silicone breast implant controversy)

       Incidence of breast implant surgery

       References

     • The second article, Silicone breast implant controversy, can be begun on a subpage if so desired. After the basic structure has been agreed upon by all parties, it can go live in the mainspace.

I will be archiving all the old naughty stuff on this page: here's to a new beginning. Throughout, please mind Wikipedia:Civility, Wikipedia:No personal attacks, and Wikipedia:Assume good faith. Do not revert war, please. I regret that I will not myself be able to take a substantial editorial role here, but I will continue to watch it in an administrative capacity. David tells me he will continue to contribute, and I hope that all of you great folks—Jgwlaw, Droliver, Midgley, Will Blake, Ombudsman et al—will likewise work together to produce a fine set of articles we can all be proud of. Very kind regards —Encephalon 12:14, 20 April 2006 (UTC)

Comments/other suggestions

Encephalon, if you look at the most recent research, you will see the evidence is NOT 'overwhelming' about systemic illness. You are wrong. I don't have a problem about most of what you said about the article, but you are wrong about the 'evidence'. It appears that others don't want any discussion about the Risks and Controversies. I don't want to be a participant in an article that did not address the true controversy. molly bloom 00:56, 21 April 2006 (UTC)

Wikipedia is not here to "address" anything, it is not a soapbox, rather it should "reflect" (or "cover") the status of a debate. Hence an article should state the consensus majority opinion, and then any disenting minority viewpoint (but does not need to give equal prominance). In this regard and for this topic, what the consensus opinion is can be debated:

• Most rheumatologists and plastic surgeons would seem (rightly or wrongly) not to be overly concerned - which forms one real-world consensus.
• Yet there can be no denying the FDA's concerns (and mirrored at least in UK too) and subsequent revoking of product licence - the FDA forms a very clear "official" consensus opinion. (foolish is any doctor who totally ignores legal licensing body or professional organisations' statements)
• The article is about breast implants and first and formost this article should cover what they are and their history. A description of their use, insertion technique, accepted specific risks should follow along with (as just another sub-section) any debate/disagreement over them. A long section on the risks is thus disproportionately to the overall article, hence my previous suggestion to split into a separate article (with suitabe cross links).

What has been most disputed is not the significance or 'value' for any one study either for or against, but rather the length given over to discussing that item (other editors' comments have talked about the length of the article rather than any specific fact over a possible risk). Even my attempt at shortening the list of studies disputing any rheumatological disease link was critised for still being too long (and having read that opinion I tend to agree). In essence only a summary of knowledge is required, as this is not a textbook. Over-lengthy subtopics in an article is poor encylopaedic writing and (irrespective of citable accuracy) risks seeming to be POV pushing (i.e. has appearence of seeming to be a POV push rather than necessarily being wrongly POV) even if it is for an uncontested majority opinion fact. I quite agree with you (?this or my talk page) that summarisation of the risks can not be ad absurdum to a single sentance, the balance is somewhere inbetween the current status and a few paragraphs (anything longer deserves/should be in a separate article). David Ruben ^Talk 02:51, 21 April 2006 (UTC)

Wikopedia most certainly is here to 'address' topics. That is the whole point of Wikopedia. Let's not dispute semantics. One 'addresses' a topic whenever one writes anything about it.

Here is one comment from a plastic surgeon I asked to contribute:

"I looked at the site and it would appear that most aspects are covered. The big gap in understanding is that Plastic Surgeons do not seem to take complications very seriously. For example, capsular contracture and even calcification in capsules is more a "vexing minor problem" and does not seem to worry most PS that this occurs regularly. There seems to be total denial of symptoms and women who complain are labelled as being 'hypochondriacs, malingerers, having a bad marriage, bad job, menopausal" or anything but implant related problems.

I often think that future generations will look back at this era and say "what did they do to women?!!"molly bloom 06:04, 21 April 2006 (UTC)

I would like to add a vote in favor of creating a new page silicone breast implant controversy. First, some disclosure:

I am new to wikipedia. I am a plastic surgeon. I do not perform augmentation mammaplasty, for a variety of reasons. I have some personal familiarity with the dispute over systemic effects of silicone gel implants [5].

I agree that my colleagues have minimized the risks of breast implants, and that a more candid discussion of these risks is over-due. However, the discussion as it stands pushes a POV quite aggressively. For example, the photograph showing "necrosis" shows not a simple a augmentation mammaplasty or implant placement, but a mastopexy (breast lift) that must have been performed with the augmentation. The necrosis is most correctly described as a complication of the mastopexy, or the combination of a mastopexy with an augmentation, and not the augmentation alone. Including this illustration in an article on implants would only be appropriate with much more explanation than is given here. The systemic illness section is an excellent essay about the evidence that does not fit with the majority consensus on this issue. Now, I personally think that there is a systemic effect of silicone gel, and that it will eventually be proven, but ignoring the majority consensus in this discussion is no more appropriate than ignoring the evidence supporting a systemic effect. I'm reluctant to start any editing of my own in this article, because it obviously very emotionally charged at this point and quite lengthy already. I think acknowledging that this is a controversy, and splitting this off into new page would allow for more contribution. DLaub 04:20, 23 April 2006 (UTC)

International

Canadian Journal of Plastic surgery -- discusses the 'generations' of implants, and the risk of rupture in older 'second generation' implants. [6] Based on the present study and other recent publications (1,6,9), about 80% of all second generation silicone-gel implants are currently ruptured or leaking. Others are expected to rupture with further time. molly bloom 01:55, 23 April 2006 (UTC)

Third Generation Implants

Cohesive gel are considered by most as 'third generation' implants. [7][8] [9][10]molly bloom 01:55, 23 April 2006 (UTC)

Implants used (and withdrawn) in other countries

The original author of this article clearly was writing from a US perspective. There have been other types of implants, & some recently withdrawn from the market. Hydrogel - Hydrogel filled breast implants are no longer available in the UK. Adverse incidents have been reported involving breast swelling associated with fluid around the implant. MHRA (formerly the Medical Devices Agency) is continuing to monitor the safety of these implants and does not recommend that women with hydrogel-filled breast implants have them removed unless they are experiencing problems. In May 2005 the Committee on Toxicity (COT)1 reviewed two animal studies commissioned by PIP. Although some effects were seen in the kidneys of the tested animals, the Committee concluded that these results suggest that exposure to the hydrogel filter will not lead to clinically significant effects in women with these implants. The Committee did, however, express concern about the lack of long-term follow up of women with breast implants.

Because of continuing concern over the safety of breast implants, MDA carried out a series of planned investigations into the safety of the various filler materials used in the products available in the UK. MDA's investigations into hydrogel-filled breast implants revealed inadequacies in the manufacturers' biological safety assessments and concluded that there was not enough information to fully assess either of the hydrogel filler materials. When they were made aware of the results of MDA's reviews, both manufacturers decided to withdraw their hydrogel-filled breast implants from the market as a precautionary measure, pending further studies to establish the safety of the filler materials. In December 2000, MDA issued two Device Alerts concerning the withdrawal of hydrogel-filled breast implants from the UK market as a precautionary measure. [11]molly bloom 00:38, 24 April 2006 (UTC)

Breast implant safety controls urged as dangers recognised (Brussels article)

Saturday, November 17, 2001 :

By Geoff Meade, Brussels

TOUGH Europe-wide controls on the safety of breast implants have been urged, but there is still no evidence they pose a "general health risk", the European Commission said.After a spate of serious illnesses among women undergoing implant surgery, and years of pressure from MEPs, the Commission says there is a need to improve the quality of implants and to set up advice and follow-up care for patients.

Up to 80% of breast implant surgery in the EU is cosmetic, and no general health dangers have been found, following major research in Madrid on behalf of the European Parliament.

But the Commission said yesterday it is widely recognised specific problems do occur, some triggered by the design and characteristics of silicone implants.

Announcing plans to MEPs in Strasbourg, Enterprise Commissioner Erkki Liikanen said: "Health issues are a major public concern, and it is our task to ensure they are addressed in the best possible way, so as to provide European citizens with the highest possible level of safety. We should be aware that, as with all implants and medical interventions, there may be inconveniences, and that patients may react in different ways.

"That is why patients should know the advantages and the disadvantages of implants and be given all the relevant information that allows them to make a well-informed decision."

The proposals, set out in a formal Commission "communication" for consideration by EU governments and MEPs, include guarantees that women considering breast implant treatment have access to independent counselling before and after surgery.

They would also be able to seek a "second opinion" and such surgery would only be considered for those aged 18 and over.

There would be compulsory national registers of every breast implant operation carried out in all 15 member states, with surveillance and monitoring of those undergoing surgery.

Long-term studies to establish the health risk would also be launched.

Silicone breast implants are already banned in the US, Japan, Canada and France - and a recent US survey revealed 69% of them rupture within 10 years.

Mother-of-two Christine Williams, chairman of Silicone Support UK, says she now regrets having breast implants to boost her figure.

She had an operation in 1979 when she was 30, and within four years began to suffer painful scar tissue.

The corrective surgery which followed was the start of a nightmare which, she claims, led to the end of her marriage and a host of health problems.

Two years later she had a second operation to replace the burst implant, but doctors found silicone leaking everywhere and removed much of her right breast and chest muscle.

molly bloom 00:36, 24 April 2006 (UTC)

Dutch physician

2004. The chance on this danger is endorsed by plastic surgeon Rita Kappel of the dutch University Medical centre St. Radboud in Nijmegen. Thousands of Dutch women with silicone implants have considerable health problems. Kappel treats much of these women. She says: Silicone breasts are for some women unsafe, very unsafe. If I remove the implants frequently all complaints dissappear."molly bloom 00:54, 24 April 2006 (UTC)

Recent Edits

External Links--I left the IRG article, but removed an editorial that is NOT a study, or a review, but merely an editorial ranting about lawyers and the horror of not having implants available for all, under any circumstance.

I agree with the edit of the 'Local Complications'. It looks good now. Thanks, David.molly bloom 15:37, 25 April 2006 (UTC)

• Molly, you commented on my talk page "I left the UK report, but why do we need to have it listed twice? It already is in the source citations. Do we want to link to every single report?".
• I agree the long list of references at one point also included duplication of citations already given in the footnotes. However I did have a v.quick look at the footnote list and did not see the www.silicone-review.gov.uk UK report included there - I still don't see it, but perhaps I need to look at the link addresses rather than the displayed text. (yes if duplicated then not needed in the reference list too)
• As for links all studies - no, but a selection would help high;ight that the literature contains a variety of views.
• Re User:DLaub, was this the surgeon you previously mentioned? I thought DLaub comments good - yes I think the article sets out well the range of complications, but could do with some mention that some research suggests other wise (operative word is some, no no need list all studies or at huge length), and likewise mention of that reserach as being subject to comments of FDA & others as to methodology (or conflicts of interest - although conflict of interest does not mean that a report is wrong, a personal assessment, but just that care is required in its critical reading).

Sub-pages for article split

In the last week or so, a number of editors (DLaub, Encephalon, Midgeley, Mike1024) have suggested a split. I think if the currently trimmed complications sections are to be edited much further (they describe the risks but now fail to mention any of the counter-arguing studies) or expanded to give a wider, less US-centric, tone then this will be beyond what one article should cover. Of course a summary of risks needs be included in the main article and an article on risks needs refer back to the description of what breast implants are. I was thinking of being bold and doing the rewrite/edit in one go, but I take note of Encephalons thoughtful suggestion of trialing out in sub-pages first (away from the "live" page). My first drafts at this break the article down into about 35kb lengths - what is considered the rule-of-thumb maximum length for a single article !

Please see therefore the non-live, subpages of Breast implant/Revised and the propossed new article of Breast implant/Risks and debate.

• Obviously the wording needs tidying up - in particuler I needed to quickly create an introduction to the risks article which I tried to obtain by aggressive summarising the main article.
• Also unlinked references need be removed from one or other article where they nolonger apply.
• The main article listing of risks needs be kept very small (ie list a concern and summary of view on this as already well done), any fuller explanatipon then is in the sparate risks article. Note I chose 'Risks and Debate' as 'controversy' suggests that risks have not been suggested - they cearly have in some of the research, there is a debate though as other studies are done as to the significance of any single report or critical reading of a single report. Dlaub's comments re likely risks, evidence perhaps not conclusively confirming thi syet, surgeons aparent lack of concern for issues or uncertainty well voiced. Can we suggest ways to take the parts of this topic (i.e. the editing sub-pages) to reflect this ? Remember whilst currently well written as an essay on the topic, it is perhaps not the best example (yet) of an encyclopaedic entry in wikipedia - hence the creaion of subpages for collaborative work by editors, as per Encephalons comments above. David Ruben ^Talk 17:42, 25 April 2006 (UTC)

If you remove the "Risks and Controversy" section, you should still leave the 'local complications' with the main article, since it is not controversial. Nobody disputes that these occur. Secondly, upon separation, you should add 'rupture' and the problem with implants & mammography in the 'local compllication' section since the fact that these occur is not controversial. Further discussion about the problems involved could be in the "Risks and Controversy" section.molly bloom 18:16, 25 April 2006 (UTC)

Indeed - I so moved the local complications to remain within the main article. I mention rupture, but not at length - the fact that it occurs is given, but with quite a lot of info on the rates of rupture and with how this is then responsible (via the leaked silicone) for the local/systemic effects given in the risks article, I did not wish to over duplicate - don't think balance is quite right yet though. David Ruben ^Talk 21:56, 25 April 2006 (UTC)

Your summarizing and 'tidying up' for an intro paragraph is excellent. Very good intro.molly bloom 18:19, 25 April 2006 (UTC)

Copied from User:Encephalon's talk page by David Ruben ^Talk 00:31, 5 May 2006 (UTC)

Looking over Breast implant/Revised and the main Talk page, I see grounds for hope, David. The beginnings of a neutral Risks section are forming: that quick edit of yours was good, and Molly has been making excellent contributions to the types of implant section. Don't worry about the article's size now, once we've more or less gotten the content in place we can begin the copy editing (I perceive that stage to be some way off). If I may make the suggestion, the headings should probably be of the format here. The current "History" section should probably be rewritten to form "Early forms of breast implant" (if we had a separate history section on the development of of implants, much of it will be redundant with "Types of implant"; if we restricted the history section to just silicone injections, "History" would be an unsuitable title). "Patient evaluation" (+contraindications) and "Surgical techniques" should be straightforward. And then of course we have "Risks and complications". I think some rearrangement in /Revised would be a good idea, David. It's probably best to split the section in two, like I said earlier. The first subsection should be on known risks and complications: op and post op issues, rupture/leak, contracture, mammography issues, etc. (In /Revised some of these bits are currently under "controversy"). The second section should summarize the history and current conclusions re: silicone implants and 1. CTD/autoimmune disorders, 2. cancers, 3. neuro, 4. miscellaneous (the platinum issue, the suicide issue), and then lead of to the subarticle. The "known" section (which we can split into individual subsections if preferred) will probably be around 4-5 paras; the controversy 1-2. Writing the second article is probably going to be the greater challenge, both because of the sheer amount of ground that will have to be covered, as well as the need to maintain dispassionate neutrality. —Encephalon 19:22, 25 April 2006 (UTC)

Anonymous Editors Making Major Edits

I would like to make a request that the edits of anonymous editors be deleted and the original material restored. This article has been very contentious, and I see an edit war re-occurring. The edits I had made previously did not delete large amounts of material that was already in the article. The recent editor has made major edits and I have restored most of what was there earlier, although I did include a study he included, with a proper context. I would request also that further edits of any kind be done on the page David provided -- and that any edits not discussed here or changed on that off-line page be deleted.molly bloom 00:41, 29 April 2006 (UTC)

• Thank you Molly - indeed all article editing, for now, should be to the 2 subpages as this article is in process of being SPLIT (see above). Also given prior edit-war, please engage in this talk-page discussion before making any significant additions or deletions to the list of studies included.
• I have therefore reverted the article back to its point prior to splitting the 2 sub pages on 25th April. Sorry Molly, can you transfer any appropriate edits across there too, otherwise dealing with the subpage work-in-progress will be impossible if the main article is also being edited in parrallel (for this reason we will need to knock the subpages into reasonable shape over the next 1-2 weeks so that the split can be made live).
• I intend to work more heavily on the subpages (revising the English as well as posing specific questions on how to expand up some of the risks debate with info Molly & others have previously had common ground over) after this (UK) May Bank-holiday weekend, so I'll be back in a few days.... David Ruben ^Talk 02:49, 29 April 2006 (UTC)

Sure, David, that will be fine. Thank you.molly bloom 03:54, 29 April 2006 (UTC)

David, I am not sure where we are now. Rob Oliver gutted the entire working articles and changed them without comment or discussion. I reverted back to the original, but I think I lost your inclusion of rupture in the local complications. Would you help with that, please? We had agreed to include a limited discussion of rupture in the 'local complications' in the main article, and discuss at length in the 'Risk & Controversy' section. I don't know how we are going to come up with any kind of article, because so far Rob refuses to cooperate not just with me, but with you and other editors as well.molly bloom 00:39, 1 May 2006 (UTC)

NCI update

NCI longitudinal update added in oncolgy section Droliver 16:35, 29 April 2006 (UTC)

Reversion of Oliver's Edit pursuant to requests by Wiki editors

I have reverted this major edit by Oliver, again. Perhaps someone else can discuss this with Oliver, as he has either not read or chooses to ignore the requested format in discussing and editing this article.

I will be happy to suggest edits in the fashion requested by those who have posted above (David, Encephalon etc). Again, in the interest of NPOV and civility, I ask that some others discuss this with Oliver. molly bloom 03:01, 30 April 2006 (UTC)

Molly, what I added was the update on that material put out last week verbatim from the NCI in their press release (which you can look up on the NCI page) on the material in that paragraph. That is about as non-controversial as it gets & if you can think of a compelling reason not to update this, please elaborate.I will respectively submit that anyone can look at the revision history of this article to see who has observed the requested editing/revision break & who has not.

Droliver 13:50, 30 April 2006 (UTC)

Yes, there is a compelling reason. If you read the discussion above, David, Encephalon and others have requested that you use the off-line article to make edits where all can discuss and edit offline. That is the reason for the revert. In fact, if you look at the history in the article, David specifically requested that we do this. David provided the off-line article to do this in.

Also, I don't appreciate your simply deleting all that I wrote. That is not cooperation, Oliver.molly bloom 16:27, 30 April 2006 (UTC)

"cooperation" does not mean that you continue to edit/revise with impunity & then get to blow the whistle when NEW material is added. I took the initiative to sharply reshape the draft when no one was touching the offline edits for days as I understood that's where we were to do it, while leaving subtle changes for the main. Your "deleted" material replaced my work in those areas prior (Which you deleted BTW) & is I feel both inflated & distorted 65.89.98.20 19:28, 1 May 2006 (UTC)rob

Discussion

"All article editing, for now, should be to the 2 subpages as this article is in process of being SPLIT (see above). Also given prior edit-war, please engage in this talk-page discussion before making any significant additions or deletions to the list of studies included."

Rob gutted the working article, without discussion. The idea of that is to DISCUSS changes with other editors, not gut all their work. We will never get a working article with this lack of cooperation. Edits that are not discussed will be reverted. Hopefully, we can get input from other editors as well. I am going to ask Dr. Laub to contribute here. Perhaps he and Dr. Melmed (the other plastic surgeon) can help. Dr. Laub is also a professor of medicine.

I agree with Dr. Laub that the existing majority view (if there is one, since the FDA has not yet approve silicone implants and other countries also do have restrictions) should be included. However, that should be in the context of the whole, and not a sentence that dismisses all controversy. The local complications should not be confined only to contracture, either, since there are other complications unique, or at least of special concern, to breast implants. We already have deleted complications that are risks with any surgery and not important to the BI article. As to the table, other editors have stated they thought it inappropriate.

I have taken Dr. Laub's suggestion and removed a photo that was a complication of both implants and mastopexy. I also am willing to work on the sections to include other findings. I am not willing to have someone unilaterally and without discussion gut the entire article.

"Qualified to chime in" on the BI article

I am not willing to have this article look like an advertisement for breast implants, or link to Rob's blog as he did on another article (which Rob was told is a conflict of interest and not acceptable in Wikopedia.) On this blog, he suggested I was not qualified to "chime in" on the BI article on Wikopedia. This is quite something, coming from a "doctor" who has been licensed less than a year. To other Wiki editors, he (unsuccessfully) attempted to portray the blog as 'independent', just as he has tried to portray his comments on this article as NPOV. His blog is a personal promotion, and has a link to his personal business website. If Rob attempts to link his blog or personal website to any Wiki article, or continues to ignore all pleas for cooperation, I will ask that he be banned and will take whatever steps I need to take to see that this happens.[User:Jgwlaw|molly bloom]] 23:42, 30 April 2006 (UTC)

Molly, apparently you failed to read the entry re. this article in the context I meant. It's a cautionary tale about the quality of internet medical literature (in general) and controversial areas on wikipedia (in particular)when partisans get involved. You're qualifications to "chime-in" aren't in question, your interest in neutral POV is (in my POV;) ) The entry ends with an admonishment to be skeptical about everything on the web and includes my own writing in that respect. (There have now been several recent articles in the mainstream press now about how controversial Wikipedia topics are being manipulated as well.) About the only commercial element to the blog is the websense-click google ads for which I recieved a check for $0.07 for the first quarter of the year! (which I think was 2 clicks) I have really tried to limit self-promotion in the blog as I hate reading all the other blogs by Plastic Surgeons which are extensions of their practice print ads. Trying to come up with new stuff is why entries come out in spurts when I get interested in something. (Please check out the "commercial" post I added yesterday discussing facial nerve palsy in face-transplants). I put the blog link in when first found out about wikipedia months ago thinking people would be interested in what I'd be writing about- I agree now (being more Wiki-familiar) that it's prob. not what should be attached in the links section of entries. BTW, I've been licensed for nearly 8 years, fully trained in two surgical specialties, completed a fellowship in cosmetic/reconstructive breast surgery, do several breast cases a week, have written on breast surgery, and am an investigator for 2 (soon to be 3) of the FDA adjunct silicone gel studies. So I do feel qualified to chime in.

You are an investigator? Then why do so many plastic surgeons who implant women with silicone implants not follow the rules? Why do so many not tell women they are even a part of the study, and do not provide them with information about it? I am collecting data about this myself. One woman today told me that her plastic surgeon dismissed her health complaints saying that implants couldn't possibly cause her problems (which are very similar to those many women experience with implants) and accused her of 'making it up'. It is no wonder the FDA did not want to use the adjunct studies. It's a joke. This is appalling. I wonder if maybe there is yet another conflict with you being an investigator, since you obviously see no reason to even have an adjunct study. That explains a whole lot.molly bloom 22:51, 1 May 2006 (UTC)

Molly, I do encourage you and anyone else to review & participate in Plastic Surgery 101 as I'm proud of it. It's definately Rob-POV & that's what a blog is for

Rob Oliver Jr. 65.89.98.20 19:19, 1 May 2006 (UTC) (sorry this machine won't accept log-on cookies)

I read the entry exactly as you intended it. You are hardly one to question my 'bias'. I did see that you attended the University of South Alabama. (They used to have a good baseball team.) You graduated in 1998, and the website has your license date as 5/25/05. You were born in 1971. That is what I found. And I was responding to your statement - you clearly attempted to discredit me (but that is not surprising, since you also called the FDA decision 'lunacy').. And yes I am suspicious of some doctors ..doctors like you who have a closed mind and ridicule regulation of your profession. A good doctor, especially one without a lot of experience, would keep an open mind. Instead, I see some plastic surgeons simply ridicule women who fear their breast implants are causing health problems that they did not have prior to implantation. That is astounding, especially since the adjunct study was not intended to be a Murphy's law where the participating surgeons decide the outcome, then plot the curve. But it seems to happen all too frequently. But that is not the issue here. You can do whatever you want on your blog. But you cannot link your personal blogs and business website to Wikopedia. Similarly, you can write whatever you want on your blog, but you cannot do so here, without cooperating with other editors. You have consistently refused to do so, instead making major changes (gutting everything I wrote) and refusing to discuss it on this forum. This is not cooperation. How many people have to request that changes are discussed here - instead of making major changes without comment?molly bloom 19:55, 1 May 2006 (UTC)

Molly that date is for one of my multiple state liscences (TN I think)incidentally some 7 or 8 years after my initial one. I agree 100% with not linking commercial sites to these articles (I still don't consider the blog commercial, but I do get the point) and I would not do that again as I've come to understand the wiki-project better. I myself have been pretty aggressive in removing links Droliver 20:11, 1 May 2006 (UTC)

First, that was not TN, because it was an Alabama website, for the Alabama medical board. But that is not relevant here.

Your blog is very self promoting, and links to your commercial site. That you can't see this is only a reflection of your inability to see your POV here. Your blog is not appropriate for Wikopedia. I also find your blog offensive and I have no interest in contributing to it, other than the statements I made in response to your outrageous statements. You can delete my comments to your heart's content there, but not here. I still don't think you 'get' the Wikopedia project, since you want still to whitewash the BI article. molly bloom 22:33, 1 May 2006 (UTC)

Attempt at Editing

Rob, here is the reason I (and others) do not want to include a chart or table of studies -for or against. This is an excerpt of what David wrote, which identifies the purpose of the article, and the split suggested.

The main article listing of risks needs be kept very small (ie list a concern and summary of view on this as already well done), any fuller explanatipon then is in the sparate risks article. Note I chose 'Risks and Debate' as 'controversy' suggests that risks have not been suggested - they cearly have in some of the research, there is a debate though as other studies are done as to the significance of any single report or critical reading of a single report. Dlaub's comments re likely risks, evidence perhaps not conclusively confirming this yet, surgeons aparent lack of concern for issues or uncertainty well voiced. Can we suggest ways to take the parts of this topic (i.e. the editing sub-pages) to reflect this ? Remember whilst currently well written as an essay on the topic, it is perhaps not the best example (yet) of an encyclopaedic entry in wikipedia - hence the creaion of subpages for collaborative work by editors, as per Encephalons comments above. David Ruben Talk 17:42, 25 April 2006 (UTC)

If you remove the "Risks and Controversy" section, you should still leave the 'local complications' with the main article, since it is not controversial. Nobody disputes that these occur. Secondly, upon separation, you should add 'rupture' and the problem with implants & mammography in the 'local compllication' section since the fact that these occur is not controversial. Further discussion about the problems involved could be in the "Risks and Controversy" section.molly bloom 18:16, 25 April 2006 (UTC)

Indeed - I so moved the local complications to remain within the main article. I mention rupture, but not at length - the fact that it occurs is given, but with quite a lot of info on the rates of rupture and with how this is then responsible (via the leaked silicone) for the local/systemic effects given in the risks article, I did not wish to over duplicate - don't think balance is quite right yet though. David Ruben Talk 21:56, 25 April 2006 (UTC)

Your summarizing and 'tidying up' for an intro paragraph is excellent. Very good intro.molly bloom 18:19, 25 April 2006 (UTC) [edit]

David, your mention of rupture was deleted when Rob deleted the whole section on local complications. Is what I wrote on rupture okay now? There is no belaboring of any of the local complications. They are as short as they can be, without eliminating them altogether, which I refuse to do.molly bloom 22:45, 1 May 2006 (UTC)