A Physician Speaks 2

[Guest guest]

http://npntserver.mcg.edu/html/SIS/newsletters/Summer1995.html

Physician SpeaksReport on the Meeting of the Silicone Related Diseases Research Study Group

Ira Lewy MD, FACP

President, Breast Implant Research

On the weekend of April 21 and 22, 1995, 49 physicians met at the Hotel de la

Poste in New Orleans, LA for the second annual meeting of the Silicone

Related Disorders Research Study Group (SRDRSG). Dr. Stuart Silverman, the

President and a member of the UCLA faculty, started the proceedings by

announcing that the American College of Rheumatology had approved the

creation of a section devoted to Silicone Related diseases. At a dinner

meeting held at Antoines restaurant, physicians from Oregon met with those from

Florida, those from Wisconsin with those from Arizona. The doctors discovered

they were in complete agreement about the truth of this disease, and the best

way to treat it. The next morning, a formal series of panels was held. First, Drs. Silverman

and Dr. , of Mt. Sinai Hospital in New York City, reviewed the

presentations from the National Cancer Institute meeting held the previous

month in Bethesda, land on the Immunology of Silicones. This have been

reviewed well in Silicone Scene and in AS-IS by several attendees from Breast

Implant Research and Dr. Espinoza of New Orleans..

Dr. Vescio of the University of California at San Diego then discussed

his findings in Dr. Silvermans patients of an abnormal protein, called MGUS

(monoclonal gammopathy of uncertain significance), which rarely occurs in

younger women but was seen in breast implant patients at a higher rate in

several parts of the country. Plans are being made by several centers,

including Breast Implant Research working with the Texas Department of

Health, to confirm these findings and those of Drs. Ballester and Vasey of South Florida and Bartel Barlogie of Little Rock, Arkansas, as

well as Dr. Silvermans group.

Dr. Alan Bridges chaired a panel including Drs. Nir Kossovsky, Smalley

and Tenenbaum. Drs. K and S presented their test results in a similar

way to those at the NCI. Dr. Tenenbaum, who has been working with Dr.

Gluck of the Arizona Rheumatology Center and Dr. Burns , presented test

results of a new assay for serum anti-polymer antibodies which is able to

detect chemical changes in the blood different from those seen on other

assays. It is not always positive either, but is a big help. Dr. Ralph Cook from Dow and Corning and Dr. Shanna Swan from UC Berkeley

continued their debate from the NCI on the true number of implanted women, as

Dr. Swan went on to make very specific criticisms of the Mayo Clinic Study by

Dr. including the decrease in the number of reported cases from the

original study protocol to the abstract reporting the results initially, then

to the final paper which was published- this is a source of error and

selection. Dr. Cook responded that a recent paper in an Epidemiology journal

corrected some of these concerns. Dr. Swan mentioned that the Mayo clinic

also reported no problems with DES causing cancer in a similar cohort study

performed in 1973, and that cohort studies often fail to detect serious

problems. The latency period of the Mayo clinic study was far too short to

allow a test of the theory that implants are safe, as were the total

women-years.

Dr. Goldsmith discussed the similarities between silicosis (silica dust

exposure) and Breast Adjuvant Disease, and has had a paper accepted for

publication on the subject. He referred to Dr. Guerridos report given at

Bethesda showing that silicone is broken down to silica in the human body,

and recommended that all implant patients be specifically asked about silica

exposure. Dr. Britta Ostermeyer-Shoab then headed a panel of neurologists including Dr.

Grisolea of San Diego and Dr. Herndon of Portland. All 3

physicians described the types of nerve damage to the brain and peripheral

nerves they have observed, as well as the nerves that control hearing and

balance. Finally, a panel on neurocognitive disorders was held and Drs.

Muriel Lezak, Prange and Boksenbaum presented the results of

their neuropsychiatric testing. They amazed the group by showing that the

rate of malingering is about 5% (willful falsification) while the rate of

previous psychiatric hospitalizations in breast implant patients was also

high (13%), and the tendency to exaggerate present in 15.3%. They all

pointed out this does not imply that there is no true disease present but

only that women are very concerned. Dr. Middleton of the UC San Diego then reviewed his series of MRI

studies of the breast on their very high degree of accuracy in predicting

rupture., including the linguine and keyhole sign.

The afternoon was spent debating protocols to be designed. These were

originally to cover a twin study, a scleroderma study ,a sarcoidosis ( lung

disease) study, and fibromyalgia study, but the group gradually agreed that

the major goal for the next year was the completion of a national database

which had been proposed and partially funded the year before, as well as

further MGUS research to be undertaken at a multi-center project.

An evening dinner program was not part of the scientific sessions, and

included attorneys for the first time since the meetings began. MGUS

findings, review of the NCI meeting Physician Speaks

and other subjects were discussed by several physicians, including Dr.

Freundlich of Philadelphia (an expert on fibromyalgia), Dr. Bridges, Dr.

Herndon and Drs. and Silverman. The evening ended with plans to

reconvene in one year at a larger location, as 29 physicians had to be turned

away from the meeting due to lack of space.

Although no specifics were announced, the sentiment at the meeting was that

our patients could not tolerate having research on silicone stopped due to

lack of funds, and that donors would be found to further important research.

Ira Lewy MD, FACP

8181 North Stadium Drive

Houston, Tx 77054

713-791-9311

FAX: 713-791-9236