Select Committee on Health Minutes of Evidence

Examination of Witness (Questions 1 - 19)




  1. Good morning and can I welcome you to this session of the Committee. May I express my thanks on behalf of the Committee to all the witnesses and those who have given us written evidence. Professor Sturrock, we are very grateful that you been able to come over today and I would ask you to briefly introduce yourself to the Committee.

  (Professor Sturrock) I am Professor Roger Sturrock. I am the Professor of Rheumatology in the University of Glasgow and Chairman of the Independent Review Group.

  2. May I ask a little about your own personal background in terms of medicine.
  (Professor Sturrock) I am a physician specialist in rheumatology. I do both rheumatology and general internal medicine but my major sub-specialty is in the field of rheumatology which covers all categories of rheumatic diseases with connective tissues disorders at one end and problems like back pain, shoulder pain and neck pain at the other, so it is a very broad spectrum of illness.

  3. May I begin by asking you, before we get onto your report and the outcome, about your general thoughts as to the pressures which lead women to undergo breast augmentation. You may not have reflected on this in particular in the report you conducted, but do you have any personal views of the background as to why women are determined to undergo this surgery?
  (Professor Sturrock) It is a very interesting question and, before coming to chair the Review Group, I suppose I had not really given it much thought. One of the things which, to a certain extent, surprised me was that, in reading through the relevant literature and listening to what people say, self-image for women is obviously very important, as it is for men, and the state of breast size is quite important, not just for cosmetic reasons but also for women's self-worth, for their confidence in society. So there are a whole range of complex reasons why women may contemplate having breast augmentation and obviously within the culture in which we live with the concept of the `body beautiful' appearing in the media, I think there are all these other subtle pressures which are put upon women which may make them think that they are inadequate in whatever sense and may lead them to consider breast augmentation.

  4. Do you have any thoughts on the role of governments in tackling the pressures on women from those seeking to market such interventions?
  (Professor Sturrock) One of the things we were concerned about in the group was the pressure of advertising and we were very concerned that, when adverts were put out, there should be a rider which indicated that advice will be available to give women all the aspects involved in breast implantation and augmentation before they go forward with it, so we were very concerned about the lack of control of the advertising aspects of this whole issue, which of course is very, very considerable.

  5. Of course, as a Committee, we took this up as an issue when we looked at regulation of the private sector and certainly we were concerned at some of the advertisements that were appearing, not so much on this area but certainly in terms of other forms of plastic surgery which was enticing people to undergo various treatments. Your Committee made a number of recommendations on the issue of providing information to women. What progress do you feel has been made so far in implementing those recommendations?
  (Professor Sturrock) I think there has been some progress. I do not know whether you have actually seen this booklet which was as a direct result of one of our recommendations?

  6. Yes, we have had a copy of it.
  (Professor Sturrock) It is now about to go into its second edition as I gather it has been sold out, so it has obviously attracted a great deal of interest and is very comprehensive in the advice that it has given. I think the next step is to construct a proper informed consent form that women would have to fill in prior to breast implantation augmentation and there has been considerable consultation with the Colleges of Surgeons and with the professional bodies in plastic surgery to produce an informed consent form, which is still not finally there yet but which I gather is in preparation, so I do think progress is being made. It is never as fast as we would like these things to be, but I was encouraged when this booklet was printed as to how well received it had been.

  7. Proportionately, of the operations currently being undertaken in this country, in percentage terms, how many are in the private sector compared to the NHS? Presumably an overwhelming number would be in the private sector.
  (Professor Sturrock) I could not give you a precise percentage because the data just is not there.

  8. Are you able to give me a guestimate that we will not hold you down to?
  (Professor Sturrock) One would imagine that approximately 80 per cent would be in the private sector.

  9. Do you think, following the recommendations that you made relating to information within your Review Group, that as well as the response from women that you refer to, the private sector have responded constructively to points that were raised about the information issues that you pointed out?
  (Professor Sturrock) I think there has been a response. Whether it has gone as far as we would like I think is another matter. We ourselves have not surveyed what is happening in the private sector as a result of our recommendations and our report but, from what we understand, certainly in the bigger private clinics, our recommendations have been taken seriously and have been considered in terms of providing better information, but I think there is still a way to go there.

Siobhain McDonagh

  10. You mentioned a little while ago that your Review Group has suggested putting health warnings on adverts. It does appear from the ones we have seen that that might well not be happening. Even if it were happening, what sort of effect do you think those warnings might have and do information booklets and health warnings have much impact in the face of the social and advertising pressures that women are under?
  (Professor Sturrock) I think that is a very good point. I suppose it is analogous to cigarette advertising. To what extent do the health warnings that appear on advertising boards and on the cigarette packet affect the buying of cigarettes? I suppose it is similar, in a sense, to putting health warnings on adverts about breast implants, but I think it is important that the warnings should be there because I think that it might make some people think seriously, "Perhaps I do need to take a little more information about this before I actually submit myself to it." I think it is important that the warning is there but, to answer your question precisely, I am really not sure what kind of effect it has in percentage-wise terms in the general public taking heed of these things if they really want to go ahead with something.

  11. Given the pressure that women are under once they perhaps want to go ahead with such an operation, is it realistic to suppose that a surgeon, with a vested interest in performing a particular cosmetic operation, will give objective advice to often vulnerable young women contemplating this type of operation? Who should be advising them? Is the doctor or the surgeon the right person?
  (Professor Sturrock) One of the things we were concerned about was the lack of information provided to the general practitioner in relation to women who might go into the private sector to see a surgeon about a breast implant and often no letter is sent to the general practitioner about that consultation. That was one of the things we were very concerned about. Often of course it is because the woman herself may not wish that to take place because one of the things we realised was that many women go for this kind of surgery and they do not even discuss it with their partner or husband or any close members of the family. It is really kept to themselves and many women may not wish their general practitioners to be informed because then it might spill out into the wider family situation, so that could be one possibility. Having said that, we felt very strongly that there should be a proper communication between the surgeon who has been consulted and the general practitioner who, being alerted to what was being considered, might therefore be able to raise a red flag as there may be some other problem that the particular lady concerned might have which might militate against her having an implant in the first place.

  12. There is a great deal of concentration on giving advice and booklets etc, but who is the best person to give that advice? Is it the GP or the surgeon? Are surgeons renowned for giving good practical advice to the women who are often feeling quite vulnerable?
  (Professor Sturrock) I am not a surgeon, so I have to be careful what I say. I think good clinical practice should involve any doctor giving appropriate advice to a patient contemplating any kind of procedure with the advantages and the risks involved in that procedure and I suppose that is part of clinical standards, which is another area that we were concerned to see improved, especially within the private sector. So, there are big issues here in terms of standards within the private sector, clinical audit and clinical standards which I know that the surgical professional bodies are very concerned to address and have been looking at ways in which that can be improved.


  13. Did I understand you correctly when you said or implied that in a situation where a GP may refer to a surgeon—and this often may involve a patient crossing into the private sector and frequently will—it is common practice for that GP to have no information back about what has happened to that patient, even when they are consenting to that operation?
  (Professor Sturrock) I am obviously only referring to breast implantation, I cannot comment widely.

  14. We are talking particularly about this area.
  (Professor Sturrock) It certainly was a feature that we were aware of that many general practitioners did not receive information from the private clinic relating to the consultation or what was being planned or even information that the surgery had taken place.

  15. So indeed the patient may go to the GP having had this operation and the GP may have no knowledge whatsoever?
  (Professor Sturrock) That is absolutely correct.

  16. The patient may possibly present with something symptomatic or relating to it and they have no information at all. Can I come back to Siobhain's point which I thought was a very important point regarding who is the most appropriate person to give advice and counselling. Surely if a surgeon in the private sector is seeing a patient referred by a GP, that surgeon has, as Siobhain said, a vested interest in that surgery going ahead because, to gain the reward from that work, the surgeon has to undertake that intervention. Do we have a need to check on that process somewhere, looking at what this Committee may recommend and looking at the way forward? Is there not some way in which we could perhaps look at a system that would ensure that taking place? You talk about a checklist, but I am looking more at perhaps detailed counselling by somebody who is independent and objective who does not have a vested interest in seeing that surgery undertaken. Have you looked at where that check might be built in?
  (Professor Sturrock) No, we have not looked specifically at that area. Of course, what is behind your question is really, will the surgeon perform the operation because of the financial incentive even if the clinical criteria for that surgery is not strong? That of course is another big issue. Every good doctor, regardless of financial incentive, should make an appropriate clinical decision for that particular patient.

  17. I am afraid we have found in our investigation of the private sector that that did not necessarily happen.
  (Professor Sturrock) I am sure that is the case. I am just saying that is what should happen.

John Austin

  18. Some of the surgeons in the private sector have a vested interest and produce the kind of advertising that appears in our local and national newspapers day by day suggesting to women that their life chances could be changed overnight by that operation. They are part of that sales mechanism, are they not?
  (Professor Sturrock) They could be part of that. This is obviously approaching a territory which the Independent Review Group were obviously not specifically concerned with.


  19. We are taking you outside your remit and I appreciate that.
  (Professor Sturrock) Yes.

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