NONFICTION - Aug. 11, 1996

SCIENCE ON TRIAL: The Clash of Medical Evidence and the Law in the Breast Implant Case by Marcia Angell, M.D., (W. W. Norton: $27.50, 256 pp.). It was jaw-dropping front-page news in 1994--the announcement that breast implant manufacturers had agreed to pay $4.25 billion to settle a class-action suit for health problems caused by all kinds of implants. The settlement is now in turnaround, but for the wrong reasons--because too many breast implant patients claimed to have been injured, not because the first major epidemiological study of implant-associated disease--published two months after the settlement was announced--found no evidence of causation.

Marcia Angell, executive editor of the New England Journal of Medicine (in which the study just cited was published), has written in “Science on Trial” a brief, sober j’accuse, and it manages to be compelling and one-sided at the same time. It’s compelling because most of the scientific evidence is on Angell’s side, with no causative link firmly established between implants and illness; one-sided, because Angell’s view is predicated on science’s “show me” positivism, unable to cope with evidence that doesn’t fit existing scientific pigeonholes.

Angell rightly points out that the breast-implant case represents a clash of cultures--between science and law, and also with journalism--but her book does as much to accentuate the clash as to illuminate it; she can’t write about lawyers and journalists without a twinge of contempt, can’t seem to understand why people might question science’s self-image as objective, disinterested, reliable.

Angell makes a good case against junk science and admirably elucidates the differences between scientific and legal evidence, but here seems intent on stamping out the “anti-scientism” exemplified by the breast implant case rather than on understanding its genesis. Maybe she should read again Thomas Kuhn’s classic “The Structure of Scientific Revolutions,” in which the late physicist wrote that science “often suppresses fundamental novelties because they are necessarily subversive of its basic commitments.”