FDA Panel Flip-Flops On Silicone
An FDA advisory panel turned down a manufacturer's request to lift the long-standing ban on silicone breast implants Tuesday. But when a different company made the same request Wednesday, the panel said OK.
It's a surprising turnaround for federal health advisors, who voted overwhelmingly to recommend the FDA allow silicone-gel breast implants to return to the U.S. market after a 13-year near-ban. However, the panel also advises designing strict conditions that will limit how easily women can get them.
Mentor Corp. persuaded advisers to the Food and Drug Administration that its newer silicone implants are reasonably safe and more durable than older versions. The 7-2 vote came just one day after a rival manufacturer, Inamed, failed to satisfy lingering concerns about how often the implants break apart and leak inside women's bodies.
Mentor Corp. presented the FDA panel with studies showing that leakage rates have improved to just 2 or 3 percent of patients. But CBS News Correspondent Sharyl Attkisson met one woman who claims a direct connection between leaking silicone implants and health problems.
Kim Hoffman told Attkisson that she got sick after her first implants from Dow leaked. When she got them replaced with a set made by Mentor, another leak made her sick again, she said.
Hoffman says the silicone implants nearly killed her, so she's been taking on the FDA and the implant manufacturer for a decade. Hoffman said she became an amateur detective of sorts, collecting damaging information on Mentor, including testimony from former company employees.
What did she find?
"Incident after incident of quality control problems, contamination issues, documents being destroyed," Hoffman said.
FDA's advisers said Wednesday that Mentor had performed more convincing research that the implants only rarely break in the first few years after they're inserted, and showed some evidence that they may last as long as 10 years.
But they stressed that sales should resume only if Mentor meets some strict conditions:
Because implant breaks don't cause immediate symptoms, patients should get an MRI scan five years after their implant is inserted and every two years. They should consider having broken implants removed to minimize risk of silicone oozing into the breast, or beyond.
"We are holding it to higher standards than other implants," said FDA adviser Stephen Li, a Florida medical device-testing expert. "This device has a 30-year history that, at best, is checkered. Given that history, it behooves us to have a higher standard."
But looking back into Hoffman's case, Attkisson reports that Mentor's relationship to the FDA raised flags to the patient. The most startling document related to Hoffman is her personal record, which Mentor is required to submit to the FDA. She was listed as having "no complaint."
So Hoffman went to the FDA and connected with an investigator who gathered reports of Mentor hiding one safety problem after another.
But according to the investigator, FDA managers seemed more interested in helping Mentor cover its tracks. He finally quit his job in disgust telling his bosses and even Congress he couldn't work for "an increasingly corrupt FDA".
The FDA closed the criminal investigation into Mentor, and Hoffman's lawsuit has been dropped, since she couldn't prove a direct link between her illness and the implant leak.
At Wednesday's hearing, doctors seemed willing to place the burden on the patient.
"Patients can determine whether or not for them it is worth it to have a device that might need to be replaced within a 10-year period of time," added Dr. Marilyn Leitch, a cancer surgeon at the University of Texas Southwestern Medical Center who also supported Mentor sales.
Women must understand that Mentor's best research has tracked implant recipients for only three years so far, said New York dermatologist Dr. Amy Newburger, who opposed allowing widespread sales.
"I don't have the assurance that it's safe," Newburger said.
The advisers wrestled with the decision and acknowledged it was a surprise given their harsh criticism of competitor Inamed's bid to sell its own silicone implants.
"They're two different devices. ... We didn't have nearly the questions on this that we had on the prior application," Li said. "Those are the reasons that will let me sleep at night."
The FDA isn't bound by its advisers' recommendations. Just 15 months ago the FDA overruled a recommendation by the panel to bring back gel implants, telling manufacturers it needed better data on durability and silicone leakage.
Silicone-gel breast implants began selling in 1962, before the FDA required proof that all medical devices are safe and effective. In 1992, complaints that the implants broke and caused illnesses prompted the FDA to ban gel implants except for patients with breast cancer or a few other conditions who enrolled in strict research studies.
Thirteen years later, silicone implants largely have been exonerated of causing serious or chronic illnesses such as cancer or lupus. Aside from the risk of breakage, they also can cause infection and painful, rocklike scar tissue.
Some 264,000 breast enlargements were performed in the United States last year, and 63,000 breast reconstructions, the vast majority with salt water-filled implants that today are sold without restriction.
Consequently, Newburger estimated that if silicone-gel implants return to the market, 200,000 women might seek them in the first year — meaning side effects that occur in only one in 10,000 people will become an issue.
Like Inamed, Mentor has tracked breakage rates for only three years in a study of about 400 people.
More reassuring to the panelists was research from a British doctor who tracked 100 of his own patients and found 5 percent of Mentor implants had broken by around nine years.
FDA scientists said the British research was skewed because it included only volunteers and excluded women at high risk of implant rupture because of rocklike scar tissue.
More troubling, when women in Mentor's study chose to have their implants removed and not replaced, they were dropped from the study, Newburger said. That means no one knows if those women continued to suffer side effects.
Mentor pledged to continue study to answer outstanding questions, and it argued that silicone implants provide enough benefit that it's unfair to withhold them from women in the meantime. Silicone-gel implants look and feel more natural than saline versions — and in Europe, where both types are sold, silicone implants are by far the most popular, the company said.
"Self-esteem ... is as integral to health and well-being as any medical issue," said Mentor chief executive Josh Levine.
Despite Mentor's efforts to prove its new products are more durable with a lower rupture rate — and convince the FDA panel that keeping a watchful eye on the company will suffice — Hoffman advises implant-seekers to be wary.
"When you get on the implant merry-go-round, you're not just having one operation," she said. "This is a repeat operation."