Science on Trial

Please note that the more or less average "average ratings" come from reviewers who either rate this one star or four to five stars. In my opinion this illustrates the main point of the book, i.e. that people either evaluate things based on medical evidence, on the opinion of experts, or on their personal belief based on personal life experience/expectations. The different ways of evaluation produce conflicting perceptions, conflicting world views which we see played out many aspect of life. I think that Dr. Angell is gutsy to even take on an issue which generates tremendous controversy. I believe that she presents the arguments for medical evidence very well. Chapter 5 is the best brief and understandable description of what medical evidence is (and is not) that I have ever read. I recommend the book on that alone. I hope that some day Dr. Angell will update the book to include more recent research.

People have a tendency to let their emotions rule their mind, or in this case, their breasts. Luckily, this book chooses the mind.

Marcia Angell's Science on Trial: The Clash of Medical Evidence and The Law in the Breast Implant Case demonstrates what can happen when members of the bar -- and some highly paid experts -- have too much imagination. We have all read that the FDA banned silicone breast implants from the market and of the many large verdicts for women who had such implants. Angell looks at the science and policy beyond both these actions. As to the FDA's decision, she notes that the law requires the manufacturer of a medical device prove the device to be safe; the manufacturers, she concludes, had not taken this rule seriously, and suffered the consequences when the political winds changed direction at the FDA. As to the jury verdicts, she takes issue with the court adversary system itself, where each side hires experts (who often make a very good living at it) and lawyers with the stated objective of proving their side, not finding the "truth." She finds this particularly problematic in the breast implant context because no peer-reviewed epidemiological study finds any correlation between the implants and the conditions alleged. However, because juries are not scientists, and because courts are often ill-equipped to decide what is "good" science, "junk" science gets into evidence, and (to her) unsupportable verdicts occur. I find many of her points well taken, but I do not believe the system needs the extensive overhaul she recommends. What is needed (and what is happening in many courts) is closer control by judges in admitting expert proof to ensure that it has some valid, scientific basis. This is a thought-provoking and important book.

This is short but wholesome book about evidence, as seen by scientists vs. lawyers. The case in question is silicone breast implants. Angell describes both scientific studies on silicone health effects, and the courtroom battles. This is also a primer in epidemiology, and of media hysteria surrounding science/technology dangers. For an European reader, this is also a horror story about the American legal system (a really good one).

For anyone interested in the interaction between science and society, Marcia Angell presents an excellent case study of what's wrong. Using her impressive credentials, she critically reviews the silicone breast implant case and examines the roles of greed, ideology, junk science, sensationalism and ignorance in this controversy. Specifically, she highlights two issues: the flaws in the legal system in evaluating science, and the rejection of sound scientific consensus. You come away with a strong sense of how people misunderstand science and of how values and politics influence science. For anybody worried about the future of science and society, this is an important book. It reinforces the perception of the decline of science in the public perception.