The MacNeil/Lehrer NewsHour

MR. MacNeil: Good evening. Leading the news this Wednesday, the White House and congressional leaders reached agreement on extending jobless benefits. Wholesale prices took their biggest monthly jump in a year, and the FDA announced plans to approve new drugs more quickly. We'll have details in our News Summary in a moment. Judy Woodruff is in Washington tonight. Judy.

MS. WOODRUFF: On the NewsHour tonight the second in our series of conversations on whether Americans are losing faith in their political system. Tonight, journalist and author E.J. Dionne, then the controversy over the safety of silicon breast implants and whether the government should crack down on their use and finally historically black colleges, equal education or not, a report on the case before the Supreme Court.NEWS SUMMARY

MR. MacNeil: A deal was reached tonight between congressional leaders and White House negotiators to extend unemployment benefits. President Bush had turned down two previous attempts by congressional Democrats to extend payments beyond the current limit of six months. He said those plans would have busted the budget. The negotiators met throughout the day in an attempt to fashion a compromise. The agreement would extend benefits up to 20 weeks. It would cost about $5 billion and be funded by closing tax loopholes and extending taxes which are now scheduled to expire. Each side blamed the other for stalling an agreement and each side said the other side had blinked in the end.

SEN. GEORGE MITCHELL, Majority Leader: And I think there has been a willingness on the part of the President to reverse his position when it looks like the actions he's taken have become unpopular. I think that was the case with civil rights as with unemployment, and I want to say that I commend him for the reverse because he's doing the right thing in the final action.

REP. NEWT GINGRICH, Minority Whip: The Democrats have come a long way towards what the President asked for, which is to pay for the bill. I mean, you know, the principle that you ought to actually pay for things is an important principle. It's tricky up here and a lot of Democrats don't seem to get the message. But most Americans understand that you ought to pay for things if you're going to buy them, and not just continue to drive up the debt.

MR. MacNeil: Wholesale prices have posted their biggest monthly gain in a year. The Labor Department today reported they surged .7 percent in October. Upward pressure on prices came from a turnaround in food costs which had been declining and sharp increases in energy costs. Most analysts called the report an aberration and not a signal that inflation was out of control. President Bush today defended himself against critics who say his overseas travels have caused him to neglect domestic issues like the economy. He made his remarks in Kansas City, Missouri, at a meeting of Future Farmers of America.

PRES. BUSH: I am not going to apologize for a single moment that I devote to promoting America's interests abroad. And when I fight for free and fair trade in Latin America or East Asia, or Europe, some will carp and claim that I'm pursuing foreign instead of domestic policy. Well, to borrow a word you all understand, that, and I'll try to clean it up for you, that is hog wash. The whole line of argument is misleading. But I don't think the American people are misled and I don't believe you are misled. I'm sure you understand that what I'm working at is a real world approach to creating more jobs and more wealth for Americans in America.

MS. WOODRUFF: The Food & Drug Administration today announced a plan to fast track the approval of new drugs, particularly those for treatment of life threatening diseases. FDA Commissioner David Kessler said experimental drugs would be approved for patients with terminal diseases such as AIDS, cancer, cystic fibrosis and Alzheimer's. Vice President Quayle said the reforms had the potential to millions of lives and billions of dollars.

VICE PRES. QUAYLE: These reforms will have a dramatic impact on the length of time it takes for new drugs to reach patients in America. Right now the average drug development and review time is nearly 10 years, too long. Under these reforms it will take five and a half years for drugs used for life threatening or incurable diseases to reach patients and seven years for all other drugs. I want to emphasize that these improvements will not, and I underscore, will not compromise safety in any way.

MS. WOODRUFF: The leading manufacturer of silicone gel breast implants today said the implants are safe and should remain an option for women who want them. Officials from Dow Corning testified at the second day of hearings before a Food & Drug Administration Advisory Panel. The company cited studies involving 1,000 women who have the implants and are satisfied with them. An FDA scientist said those studies did not measure health threats or long-term risk. We'll have more on the story later in the program.

MR. MacNeil: The Supreme Court today heard arguments about Mississippi's efforts to reverse segregation in its colleges and universities. The Bush administration and a civil rights lawyer argued that the state had not gone far enough and was obliged to compensate black institutions because they were deprived of equal funding for many years. Mississippi's Special Assistant Attorney General said the state had fulfilled its obligation to promote equal education by instituting race neutral admissions policies at all its colleges and universities. Both sides talked about the case outside the court.

WILLIAM GOODMAN, Lawyer for the State of Mississippi: Well, we are dealing here with people. We're not dealing with physical places. And what this case ought to be about and what I tried to say and what I think ultimately it will be about is equal opportunity for people, not equal opportunity for places.

ALVIN CHAMBLISS, Civil Rights Lawyer: I think the issue is desegregation and whether or not the state, all state universities, in particular the black universities, will be equal partners in the educational process, and up until now they have not, and I hope that in the future we will go ahead and hand together.

MR. MacNeil: The Justices are expected to rule on the case by July and we'll have more on that story later in the program.

MS. WOODRUFF: There were new efforts to bring peace to Yugoslavia today. The European Community's top negotiator met in the capital of Belgrade with the Serbian republic's president. He reported progress on talks about a new cease-fire and the possibility of deploying a peacekeeping force. Meanwhile, the Serbian-backed federal army temporarily halted its bombardment of Dubrovnik. The army delivered a brutal attack on the walled old city in the Croatian port yesterday. The shelling continued through this morning and then stopped to allow European Community monitors and residents to evacuate. Paul Davies of Independent Television News filed this report by telephone from the besieged city.

MR. DAVIES: There's been an opportunity to inspect the damage inflicted by yesterday's bombardment of the old city, its medieval walls blackened where they were struck by Soviet-made wire guided missiles. Shells crashed into old towers and into houses. Some started fires. Croatian Radio says 23 people died in yesterday's attack. The fear now is that we only seeing a temporary respite in the fighting and that the killing and the destruction will continue.

MS. WOODRUFF: Federal army officials said they had nearly captured another key Croatian town, Vukovar. The town is just across the border from rival Serbia and has been under siege for three months. The army said its Croatian defenders were trapped in its center and it's calling on residents to surrender. Congressional Democrats today withdrew a proposal to make up to $1 billion from the defense budget available to the Soviet Union for emergency food aid as well as assistance in de-militarizing the Soviet economy. The authors of the plan argued that it was in the U.S. interest to prevent a breakdown of central control in the Soviet Union. The proposal was withdrawn because of limited support in Congress and what Senate Armed Services Committee Chairman Sam Nunn described as "tepid and ineffectual support" from the White House. That's it for the News Summary. Just ahead on the NewsHour, a conversation about what's wrong with American politics, the debate over breast implants and arguments over segregated colleges. CONVERSATION - MANDATE FOR CHANGE

MR. MacNeil: First tonight we continue our series of conversations this week on what's wrong with the political system. This week President Bush has been lambasting congressional Democrats who in turn accuse him of panicking because he's fallen in the polls, but frankly, Scarlet, do most Americans give a damn? The Washington Post reports that faith in government has been steadily eroding since the days of Dwight Eisenhower. In 1958, 75 percent of Americans trusted government to do what is right most of the time. That confidence is said to be shared today by only 36 percent of Americans. What is causing this erosion? We explore that and other issues now with E.J. Dionne, Jr., a political reporter with the Washington Post and author of the book published this summer "Why Americans Hate Politics." Mr. Dionne, thank you for joining us.

MR. DIONNE: Good to be with you.

MR. MacNeil: Is this just a bad patch for the political system, a case of the blues, or is there something fundamentally wrong, do you think?

MR. DIONNE: I think this has been going on for a long time. As the chart showed, it's really been a problem ever since the days of Watergate. And I think that right now people are feeling it more acutely because of the economic troubles. I think, as it's often said, when the economy goes bad, everything goes bad. And so I think when politics fails people at a time of economic trouble, they really get angry. But I think this trend has been with us for a long time. And I think it grows out of a sense that people have that we've really had nothing but a series of rather phoney discussions over artificial or contrived issues mainly coming out of the moral debates of the 1960s. I think what we've gotten away from in our politics is what people used to come to politics for, which was to solve problems and resolve disputes. And they don't sense that our politics is doing that now.

MR. MacNeil: Well, tell us which phoney issues are being, are you referring to.

MR. DIONNE: When I talk about phoney issues, in fact, I'm really talking about the very use of the word "issues," which I think gives the game away, that what people really want to talk about in politics are problems, and issues are used from campaign to campaign for some purpose. Problems are there to be solved. A good example I think is crime. Crime is a real issue. People are genuinely concerned about it. They're right to be concerned about it. But, instead of talking about what you might do to solve the problems of crime, we have endless debates about the death penalty. Now there's a lot to be said about the death penalty, but the death penalty won't do much about most of the street crime people are worried about. Congress just passed a bill where they made it a federal crime, a capital crime, to kill federal egg inspectors. Now we all care about the lives of federal egg inspectors, but I don't think that's what people are interested in when they ask politicians to do something about crime. And I think you see that on issue after issue. The other one that I think bothers a lot of people in the country is when we have these debates that cast feminism as the enemy of the family. The truth is most Americans are for feminism and for the family. They're for feminism in the sense that they think women are in the work force to stay. A lot of families would fall below the poverty line if women didn't work. At the same time they are uneasy about what's happened to kids in the new family. Both parents are being driven out of the home too much. People don't want a kind of polarized debate about feminism versus the family. They want to figure out how to make the new family work. And I think they sense our politics really isn't helping them much resolve that problem.

MR. MacNeil: Are you also referring to abortion?

MR. DIONNE: Well, I think abortion is one of those issues that you can't call phoney because it really matters to a lot of people in a deep sense, that if you are a right-to-lifer, believe abortion is murder you have to oppose it and you have to oppose it strongly. If you believe that abortion is a fundamental right, then you have to support it and you'll support it strongly. But I do think even on abortion Americans are uneasy with the discussion. If you look at the polls, you find an odd thing, which is, on the one hand, if the question is cast, do you think the government should meddle in abortion, most people don't like the idea of government meddling, but if the question is cast, are too many abortions performed, should we try to reduce the number of abortions, people say yes. But when politicians talk that way, if they talk about trying to seek some middle ground on the abortion issue, everybody on each side of the debate jumps down their throat. So I don't think abortion, itself, is a phoney issue, but I think we made it very difficult to have an honest discussion about it in the way that reaches most people where they are.

MR. MacNeil: Would you include the flag burning issue and the calls for a constitutional amendment to outlaw it, and the defeat of that, would you call that another one of those issues?

MR. DIONNE: Well, flag burning I think, flag burning and the whole Pledge of Allegiance issue is a very interesting array of questions. And I think people care about what's underneath those questions even though issues, themselves, I think are raised mainly for phoney purposes. I mean, take the Pledge of Allegiance issue in the schools which President Bush used against Michael Dukakis. I think what underlies that is a real debate the country would like to have over what do we want our schools to teach. Should the schools teach just knowledge and skills, or should they teach values? If instead of having a debate that focused narrowly on this Pledge of Allegiance issue and whether the kids of Jehovah's Witnesses should be forced to say the pledge and instead we talked a little more rationally and quietly about what do we want out of our schools, again it's another area where I think people would be drawn back into the debate and not just see it as something that politicians make up as they go along.

MR. MacNeil: But doesn't your latest reporting since your book - - I've been reading the series you and David Broder have been running in the Post -- doesn't it show that even if politicians talked about the real problems and how they might be solved, the people no longer, or many of them, no longer believe Washington can solve them?

MR. DIONNE: I think that's a good point and I think that it explains something that a lot of people have been making fun of lately. People have been making fun of the voters for saying on the one hand we want more services, we want national health insurance, and on the other hand, the voters have been saying we want lower taxes. I don't think the voters are being irrational in saying that. I think what they are trying to say to politicians and what they certainly said when David and I and all our other colleagues went around the country is that they think the tax system has become unfair to middle income people, especially middle income people with kids, and if you look at the statistics, that's true. Those are the people on whom taxes have gone up the fastest. At the same time, they say, look, government isn't really doing things for us anymore. If there's a hero in my book, it may be the GI Bill. And I reason I like the GI Bill and I think a lot of Americans did is because it did two things simultaneously. On the one hand, it extended the basics of middle class life very broadly, meaning a college education or a shot at college and a chance to own a home. At the same time it linked those benefits to a sense of obligation. People whom we were rewarding with the GI Bill were people who had risked their lives for their country. And I think Americans looked at the GI Bill and said, yeah, that is the sort of thing that government should do. We want to help people out to get into the middle class and stay there, but we also think people should give something back. I think if politicians started speaking in terms of that sense of reciprocal obligation and how can you use government to build and strengthen the middle class, you wouldn't have this sort of alienation, you wouldn't have people saying, it's hopeless, the government is never going to do anything for me anyway.

MR. MacNeil: How would a candidate, Presidential or congressional, translate what you're saying into effective politics in 1992?

MR. DIONNE: Well, I think you've seen it here and there. I think, for example, Harris Wofford's campaign in Pennsylvania was an attempt to talk about some real things and it resonated with voters. When he started talking about national health insurance, he was addressing people's concerns not only that they might lose their health care, but he was talking more broadly about their worries over what was happening to the economy and what was going to happen to their benefits over the long run. I mean, I think when voters look at Washington, they think a little bit of a line in a rock song which goes "It's the end of the whole world as we know it and I feel fine." I think most Americans are prepared to listen to a candidate say, look, it's not 1955 anymore, America is not the most, the dominant economic power in the world anymore. People know that that means there are challenges to us, that we have to work harder, we have to work smarter, we need better training, we've got to do more in schools. If candidates talk very specifically about the challenges America faces in the 1990s and how different the world is now than it was when Dwight Eisenhower or John Kennedy was President, I think voters would respond. And I think that would be a way of ending this sort of inward- lookingness in the electorate that so many people attack. I don't think the electorate is either crazy or selfish. I think they would like to be challenged to deal with the problems that they know are affecting their own standard of living.

MR. MacNeil: Do you mean to say that you think the voters instinctively or in fact understand the harsher economic realities of a more competitive world in which the American standard of living won't by sort of divine right keep rising every year better than the politicians do, or at least the politicians are saying?

MR. DIONNE: I think the politicians are afraid of talking about it. One of the things that struck us when we were going around the country talking to people is that they were very aware of this. They weren't pulling their punches. They knew that we faced a challenge that we didn't face before and they also knew that if we don't work smarter, if we don't study more, if our schools aren't better, and the schools came up over and over again when we were talking to voters, if those things don't improve, we will face a continued slow decline. And I think one of the reasons this recession has had such a powerful political impact is that voters are linking up short-term economic difficulty with this long-term problem. I think they know it and I think they'd like to hear politicians talk about it.

MR. MacNeil: And yet all the wisdom among political campaign strategists and campaigners is that's the wrong message. I mean, look at Mondale in '84 who said, Bush says he won't raise your taxes, I say I will -- or Reagan says he won't, I say I will.

MR. DIONNE: But I think if candidates lead by saying I'm going to make you suffer and by the way, maybe in the long run it'll get better, I don't think voters will listen, I don't think they'll trust that candidate. I think what they want a candidate to do is get out there and say, look, here is what we need to do, here is how it will improve your standard of living, improve your kids' chances of doing better. And that's another issue that comes up over and over when you talk to voters. And if a candidate laid out a plan to make things better, then maybe taxes for specific things would become acceptable. But I think if candidates simply say, well, you've got to pay because we need to pay off this deficit that we built up, I don't think voters will listen and I don't think they're cynical in saying, look, we want candidates to do better than that.

MR. MacNeil: Does it strike you as ironic that all this dissatisfaction with this political system has arisen just at a time when American democracy is being touted as the model, especially for those countries that have just rejected Communism?

MR. DIONNE: That's exactly how I begin the book. I think it is remarkable that at a moment --

MR. MacNeil: Do you see a connection between the two?

MR. DIONNE: Well, I think that, in fact, the increasing mistrust of politics and politicians is not confined to America. Even on this I think we're leading the way in the Western world. In Europe right now, they are also having terrible problems with declining voter turnout, with increasing mistrust of their political classes. You have the growth of a lot of sort of far right movements in France and Germany, very far right, almost neo-fascist movements, which reflect this uneasiness. I think that the other lesson to draw from that both for us and for the Europeans is that we have spent an awful lot of time talking, on the one hand, about the economy and on the other hand, about government. But there's a third thing on which both democratic politics and a market economy rest, and that's society. And that's all of those institutions, notably the family, that we rely on to give people a sense of values, to give them a sense of ambition and drive and all the other things, and that in a way we have allowed the market and the state to invade the family and we haven't strengthened these basic institutions without which societies collapse. And I think that's another thing that voters are asking for is a certain realism that says, look, the free market does great things to produce goods but it's not really going to raise your kids, it's not really going to give us the values we need. The free market is not enough. Government isn't going to do those things. We've got to strengthen those intermediate institutions, especially the schools and the families, and also the churches and the neighborhood organizations. If we don't do those things, then the society on which our very system is based is going to collapse. And I think that lesson applies throughout the West right now.

MR. MacNeil: Well, E.J. Dionne, thank you very much for joining us.

MR. DIONNE: It's been good to be with you. Thank you.

MR. MacNeil: Judy.

MS. WOODRUFF: Still ahead, the debate over breast implants and the arguments over black colleges and segregation. FOCUS - RISKY PROCEDURE?

MS. WOODRUFF: The controversy over whether or not to ban breast implants is next tonight. Just outside Washington this week, a Food & Drug Administration advisory committee is grappling with that question. We'll sample the debate in a moment. First Correspondent Elizabeth Brackett has this backgrounder.

MS. BRACKETT: Over 2 million American women have had the same surgery this woman in Chicago had this morning. Unhappy with her breast size, she wanted breast implants to make her breasts larger.

DOCTOR: Her biggest complaint really is, I mean, she'd like to be fuller up top, up towards her clavicle.

MS. BRACKETT: Almost 3/4 of breast implant surgery is done for cosmetic reasons. Another 1/4 is done for medical reasons, usually after a woman has lost a breast to cancer. Most women are happy with their implants, according to a national survey sponsored by plastic surgeons. But that was not the case for 32 year old Melanie Croft.

MELANIE CROFT: [Crying] After what I've gone through now for the last two years [pausing, crying], if he had told me before, I wouldn't have done it.

MS. BRACKETT: Croft had silicone gel implants inserted three years ago. She had long been unhappy because one of her breasts was smaller than the other. But shortly after the surgery, she began having health problems she had never had before.

MELANIE CROFT: I've had a lot of arthritis type problems. I was diagnosed with connective tissue disease, chronic fatigue syndrome. There's days I couldn't get out of bed. I had immune problems. I was always sick. I mean, it wasn't just like I got a cold. I would get bronchitis. I was in and out of the hospital twice with the stomach flu. I had ear problems. I have lung problems, which I still have severe lung problems. I had burning in the joints. I had hip problems where it would hurt to walk.

MS. BRACKETT: For two years, Croft went to doctor after doctor. No one connected her many symptoms to her breast implants. After seeing another woman's story on television, Croft began to think her implants could be the problem. She had her implants removed six months ago and says she is beginning to feel better.

MS. CROFT: I still have the lung problems. I still have arthritis. I'm in physical therapy twice a week for my shoulders and my arthritis. But I'm getting better.

MS. BRACKETT: Do you think these implants should be taken off the market?

MS. CROFT: If they're going to make a decision, if they're going to keep implants on the market, which I feel they shouldn't, but if they're going to, I think these women need the information. I think they have to know about people like myself that are sick, have never been sick before in their life.

ANN MARCOU: [On Phone] But you have to weigh the benefits against what the side effects may be and, you know, it could be that you'll come out way on top with tolerating side effects because of the benefits you could get from it. If it's going to put your cancer in remission, that's the important thing.

MS. BRACKETT: But 59 year old Ann Marcou has an entirely different story. The founder of Why Me, a hotline for breast cancer patients, Marcou herself had a double mastectomy 15 years ago. After losing a prosthesis while swimming, Marcou decided it was time for implants. She remembers the surgery well.

MS. MARCOU: Oh, dear, it was like a miracle. I can still remember the doctor coming in the morning after the surgery and taking the bandage off and I looked at my chest and I said, oh, my God, and burst into tears. It is a very moving experience.

MS. BRACKETT: Why did you cry?

MS. MARCOU: I think, I just can tear up on it, just thinking that I could have my breasts back again, that I didn't have to have this hollow nothing on my chest. Well, the scars are there, but you have something more than scars.

MS. BRACKETT: About 1,000 women a month call the Why Me cancer hotline. Many calls are from women who are having a hard time confronting their cancer. Marcou says if silicone gel implants are not available, it will make women fear cancer surgery even more.

MS. MARCOU: I think women who have a very strong breast issue are going to think twice. They can have a lumpectomy, but not all women are good candidates for a lumpectomy. And if they think that that can't be done for them, for instance, if they have a large tumor, then they can still fall back, knowing that they can have a recreated breast and feel that their life can go on normally from there. Many women don't feel that they're going to have a normal life unless they can have a normal figure.

MS. BRACKETT: This is the type of implant that is used more often today by plastic surgeons. It has a textured silicone covering and it's filled with a silicone gel. Many of the women who have gotten sick after surgery say they think it was because the silicone leaked out of their implants and caused an adverse reaction in their body. But plastic surgeon Dr. David Ross, who has done breast implants for the last 20 years, says that is just not accurate.

DR. DAVID ROSS, Plastic Surgeon: This vision of the material oozing or leaking throughout the body is grossly incorrect. We are aware of what we call "gel bleed," which is a microscopic passage of silicone within the implant to the surface of the implant, and then it can be perhaps picked up in the scar tissue around the implant. But as far as oozing throughout the body, this does not occur.

MS. BRACKETT: Dr. Ross used silicone gel implants for Barbara Runyard's surgery six years ago. Several years after the surgery she joined his staff. She says her implants, which were done for cosmetic reasons, improved her self-esteem enormously. She says if the implants were taken off the market, she would worry about her own future.

BARBARA RUNYARDS: It makes me extremely nervous. If something were to happen to me, if I was in a car accident or one of my implants broke, I'd have no, you know, nothing that I could do. I'd have no recourse. I'd have to just have both of them removed. and for people that have had it done cosmetically, you know, for cosmetic reasons, you know, I think it could be devastating.

MS. BRACKETT: Plastic surgeons who use silicone gel implants in breast surgery continue to insist that the benefits far outweigh the risks. The Federal Drug Administration's Advisory Panel that is now meeting in Maryland is scheduled to announce its recommendation on the use of silicone gel implants tomorrow.

MS. WOODRUFF: And the Food & Drug Administration is expected to make its final decision in January. We get four views now on the risks and benefits of breast implants from people who testified before the FDA Advisory Panel. Karen Berger is the author of a book titled "A Woman's Decision," for which she interviewed hundreds of women who have had breast implants. Dr. Sidney Wolfe is director of the Public Citizen Health Research Group, a non-profit organization that monitors the FDA and Congress on health issues. Cindy Pearson is the program director of the National Women's Health Network, an advocacy group that has opposed breast implants. And Dr. Roxanne Guy is a Florida surgeon with seven years' experience in plastic surgery. She is a member of the American Society of Plastic & Reconstructive Surgery. Ms. Pearson, I want to begin with you. Breast implants have now been done for what, thirty or thirty-five years. Why has this great controversy and debate over whether they should be taken off the market arisen now?

MS. PEARSON: Breast implants may have been on the market for a long time but they haven't been studied carefully for a long time. Unfortunately, even though over a million women have used them, we still have no conclusive evidence that they're safe. And we have some suggested evidence that they may not be safe.

MS. WOODRUFF: How could that be? How could they have been out there and available and implanted in what I read 2 million American women and there be such doubts, as you're suggesting?

MS. PEARSON: I think the reason why there are doubts is that breast implants are put in by surgeons who typically and especially until recently don't follow up their patients for other than surgically related problems. So if breast implants are causing auto immune disease, as some researchers suspect, a surgeon wouldn't be the most likely person to follow up a woman who had complaints of pain or arthritis or scleroderma.

MS. WOODRUFF: And up until now you're saying there has been no systematic attempt to follow these women up who've had the implants done?

MS. PEARSON: Apparently not. I spent all day at the Food & Drug Administration hearing and I was shocked to see that Dow Corning, the leading manufacturer of silicone gel-filled implants, submitted data on just 1,000 women who had been followed only an average of two years.

MS. WOODRUFF: Dr. Guy, you're a plastic surgeon. You've done surgery involving implants what, for six, years, is that right?

DR. GUY: Seven years.

MS. WOODRUFF: How do you explain the fact that it's been done for so long and yet now these questions are arising, problems are in the public eye that apparently weren't before now?

DR. GUY: The implants have been on the market for 30 years and they were not regulated by the Food & Drug Administration during that time. The Food & Drug Administration had that mandate in '76 and they grandfathered the implants in, assuming that they'd been on the market and they'd been working effectively for the past several years, and so there's not a reason to suspect that they're a problem. What's important to remember is that these are presumed problems. There is absolutely no scientific evidence that these diseases are linked to silicone or to the implants.

DR. WOLFE: What diseases?

MS. WOODRUFF: Dr. Wolfe, if youdon't mind, I'm asking the questions here.

DR. GUY: The immune diseases.

MS. WOODRUFF: And the immune diseases that we also saw from one of the women who Elizabeth Brackett interviewed, a Miss Croft. Dr. Wolfe, you just heard Dr. Guy say that there's no scientific link between these serious diseases and the breast implants. You're disputing that. What do you base that on?

DR. WOLFE: Well, one of the leading researchers in the area of rheumatology, Dr. Steve Weiner, at UCLA, told me today that he estimates there are about 25,000 women in this country with breast implants who have a very unusual kind of syndrome which is pain in the joints, some muscle pain, and some nerve pain, which is very different from typical rheumatoid arthritis. It just doesn't look like it and it doesn't respond as rheumatoid arthritis does to aspirin and those kinds of drugs. There's also evidence apparently presented today by someone from Dow that back in 1975 he did studies in animals showing increased immune responsiveness on the part of animals to silicone. So there's some animal evidence and there's certainly --

MS. WOODRUFF: And you're saying that constitutes a direct link?

DR. WOLFE: There isn't conclusive causal evidence, Dr. Guy is right, but more and more rheumatologists are seeing these cases and they just don't look like the usual kind of rheumatoid arthritis. The women that have these are much more likely to have the hard shell around the breast implant, they're much more likely to have had a rupture. Certainly ruptures are something that have clearly been established. We've looked at data collected by the plastic surgeon showing about 150,000 women who have had breast implants, have had rupture, leak or some other complication like an infection.

DR. GUY: I think you're misinterpreting the data there as you did yesterday, and as you were called down for at the Food & Drug Administration yesterday. That data has been manipulated. That came out of the ASPRS survey that was done a year ago.

DR. WOLFE: That was the percentage of women who have the complication.

MS. WOODRUFF: That's a plastic --

DR. GUY: That was not the percentage. A hundred and fifty thousand is not a percentage.

DR. WOLFE: It was projected. The plastic surgeons, themselves, said this is a representative sample of all women in the country who've had breast implants.

DR. GUY: And what percentage is that, Doctor?

DR. WOLFE: Well, what it was with the women with augmentation - -

DR. GUY: It was 5 percent, Dr. Wolfe.

DR. WOLFE: It was 5 percent for augmentation and about I think 10 percent for women with reconstruction.

MS. WOODRUFF: You all are citing I think some numbers and some studies that we haven't introduced here. Ms. Berger, can you shed some light on this?

MS. BERGER: Well, I think we're missing the issue. I've spent the last 10 years interviewing women about this and I just surveyed 950 women who have breast cancer. And the statistics, the thing that I find is that these women want breast reconstruction. Most of them when they select a type of breast reconstruction, over 75 percent, select implants. The reason they select implants is they're cheaper, it's less surgery, you don't have new scars. It's less time consuming, less recuperation. And for many of these women who have bought into the American ideal of being thin and fit this is the only option. The satisfaction level when asked if they have problems and what the complications are is 89 to 90 percent.

MS. WOODRUFF: I think what we're really discussing here is the safety question and whether they are, whether there is --

MS. BERGER: The fact is there are no definitive studies. I'm also on the medical side. I'm a medical publisher and I've read all the studies. There are no definitive studies that document a connection between scleroderma, lupus or any of these connective tissue diseases and implants.

MS. WOODRUFF: But as I understand the argument, the point of those who would like to see the breast implants either taken off the market completely or at least partially, their argument is since these studies haven't been done, let's do something to withhold the breast implants until we know that they're safe. Is that not -- am I portraying that argument correctly?

MS. PEARSON: That's exactly the point, Judy. Women, often the surgeons say this is a woman's right to choose. Well, women in America had the right to choose the Dalcon Shield and dozens of women died because of that and two hundred thousand women claim they were harmed because of it. That's the reason why we now have the authority to go to the FDA and ask them to review devices for safety and effectiveness.

MS. WOODRUFF: All right. Dr. Guy, what about that, I mean, is it unreasonable to say let's either restrict or ban something until we know for sure that it's safe? I understand that's what their argument to be.

DR. GUY: Well, first of all, the Dalcon Shield, that's comparing apples and oranges. That wasn't on the market for 30 years with proven safety over --

DR. WOLFE: It was what precipitated the --

DR. GUY: -- 30 years' time. If the devices are taken off the market, they will not be an option later. If the devices are taken off the market, many women have the perception in the United States that sure, we'll take these implants off the market for a year or however long it takes to get these studies and then they'll be right back on. That is not going to happen. Dow Corning has stood behind its implants and has done research, ongoing research for 30 years. And you can't take that product away from the company and expect that company to go on.

MS. WOODRUFF: What are you suggesting?

DR. GUY: They simply won't be available.

MS. WOODRUFF: You're saying --

DR. WOLFE: Other companies are going to come up with safer implants though. I think that's the --

MS. BERGER: There's a bigger health issue here though that I think is very important.

MS. WOODRUFF: I'm sorry, which issue?

MS. BERGER: It's a health issue, and this was raised yesterday at the hearings, and it's something I raised and a number of oncologists raise. Many breast cancer specialists say that if these are taken off the market, what is going to do is incidents of women dying from breast cancer is going to go up.

MS. WOODRUFF: Why?

MS. BERGER: Because now what we're finding is a lot more early detection. There are younger women developing breast cancer and the reason is the women I'm interviewing now are in their twenties and thirties when they're finding it. They're coming in, they're examining themselves, they're doing BSE because they know they can have breast reconstruction. And there are lots of women that's, implants are their only --

MS. WOODRUFF: And you're saying they're delaying treatment for the cancer?

MS. BERGER: They will and they have, and I have talked to women who have said to me, if I can't have breast reconstruction, if I can't have my breasts back, I'm not going to have treatment.

MS. WOODRUFF: You're shaking your head, Ms. Pearson.

MS. PEARSON: No, there's no back-up for that. The only people who are saying that are people who have a financialinterest in seeing the continued provision of this one particular type of implant. In fact --

DR. WOLFE: There are other implants which aren't going to be taken off the market, Judy.

DR. GUY: Do you see patients? I see patients. I am a practicing physician. I was a general surgeon first and I saw women who stayed at home a year or longer because they had a breast lump. They knew they had a breast lump. I saw them coming in with their cancers in the stage of draining.

DR. WOLFE: Even with implants available is your point.

MS. BERGER: Well, I have a high risk for breast cancer. I have the family history and I have decided myself that if I ever develop breast cancer, which is great likelihood, that I would have implants. I don't want my choice taken away from me.

MS. WOODRUFF: The question, some of you have already brought this up, there are other implants, other substances that are available as implant fillers, is that correct?

DR. WOLFE: This action is only -- right.

MS. WOODRUFF: And I understand one of them is saline?

DR. WOLFE: Salt water, which is what the body is made of.

MS. WOODRUFF: Another one is making the implant out of the woman's own body tissue. Is that a --

DR. GUY: Either one of those.

DR. WOLFE: I talked with a plastic surgeon in California who said that most of his patients after he explains the risks to them of the silicone gel and the risks of saline choose to have the saline implant. I also talked to another plastic surgeon who was one of the leading advocates of silicone gel breast implants who did carefully review all of his patients and in 1985 he stopped putting these in because he didn't think that the high complication rate could go along with his continuing to recommend these.

MS. WOODRUFF: Dr. Guy, what about using these other kinds of implants while this silicon implant were studied, for example?

DR. GUY: Well, I do tell my patients about all of the different types of implants that are available on the market and there are advantages and disadvantages to all of these implants. The disadvantage of the saline implant is that it's not for everybody. In many cases, especially slim women, and especially women who have had a mastectomy whose tissue is somewhat thin over the area, you can feel a difference. They don't feel natural. They don't have the same natural feel that the silicon does. Often you can audibly hear the saline and often you can feel the edges of the implant better than the silicone.

DR. WOLFE: But you do put them in some women?

DR. GUY: Absolutely. I give patients a choice.

MS. WOODRUFF: And let me just come back to you, Ms. Pearson. The argument they're making, among other things, is that this denies women a choice, that at the very least what's wrong with giving women an informed choice, saying you have the choice to do that, here are the risks, as long as you know what's going on, it's your decision?

MS. PEARSON: I'm delighted that my mother and my aunts were denied the choice of thalidomide. Thousands of babies were not harmed with birth defects caused by that drug in this country because the FDA used its power to regulate the safety and effectiveness of drugs coming onto the market. And because of the Dalcon Shield, the FDA now has that same power to regulate the safety and effectiveness of devices. And all we're saying is let the science decide, the science that isn't adequate yet to support the safety of these devices.

MS. WOODRUFF: What about that point?

MS. BERGER: What bothers me is a small group of people who are unhappy are trying to mandate choice for a large number of women who are very happy. I have talked --

MS. WOODRUFF: But it's more than unhappy. I mean, it's women who believe that their health has been threatened.

MS. BERGER: But one doesn't know and no one has established exactly what the causes of that is. I mean, every surgery, every operation carries risks with it, and to identify exactly which risks they were, I mean, every patient knows that. You go in for an appendectomy and you have a risk. You go in for a hysterectomy. The fact is there is a lot of good there. There is a very high patient satisfaction number and I would beg to disagree with Dr. Wolfe about the complication rate being so high. The complication rate is not that high.

DR. WOLFE: Well, it is high. I mean, even a rate of rupture or infection of 5 percent means really over a hundred thousand women have a problem. Just in the last two and a half years alone there have been six hundred cases of rupture reported to the FDA, nine hundred cases in which the implant had to be removed. And that's just a tenth of the entire size of the problem. But I agree with Cindy, women should have a choice between various safe products, as between, as opposed to a choice between a very unsafe product and, as Dr. Guy admits, saline is on the market, it will stay on the market and women will be able to choose that until a safer product becomes available.

MS. BERGER: You mentioned tissue being transferred. That procedure is called the tram flap, where abdominal tissue and muscle are transferred to build a breast. But what people don't understand is, one, that isn't for everyone, that is a six to eight hour operation, it is major, major surgery. If you are slender, you're not a candidate. If you smoke, you're not a candidate, because of your blood supply. If you have major health problems, you're not a candidate or if you don't want to spend the money or the time.

MS. WOODRUFF: All right. Let's talk about the options, just quickly, that the FDA has. As I understand it, they've been laid out as either a complete ban and, of course, studying the implants, keeping them on the market completely, as they are now, and studying them, or a middle ground, which would be to restrict their use to either women who have had say mastectomies and want reconstructive surgery or coming up with some definition of who might have, to whom they might be available and others they might not be. What about this middle ground, Dr. Guy?

DR. GUY: Well, I think that would be a tragic disservice to the 100 million women in America. That, in effect, will tell the cancer patient you're going to die anyway so it's okay to have this product in here, whereas, a patient who is healthy, we won't put this product in a healthy patient. I think that's the wrong message to get across to the women of America.

MS. WOODRUFF: As far as you're concerned, the only solution is just to leave the supply on the market?

DR. GUY: The implants have been proven to be safe and effective.

MS. BERGER: Continue research, have a national registry so that you have more information, rewrite the package inserts so that they're perfectly, and a lot of package inserts aren't as understandable to patients as they should be, make sure it's a total informed consent, but, you know, a lot of women say that one of the things, and I would agree with Dr. Guy, one of the best things about hearing they can have reconstruction is it makes them feel like they have a good prognosis, and don't take that away from them.

MS. WOODRUFF: What about that, Ms. Pearson?

MS. PEARSON: Breast cancer --

MS. WOODRUFF: It's such a psychological boost for these women.

MS. PEARSON: Why give women a false sense of security? If breast implants haven't been demonstrated safe and if the manufacturers in the last 15 years since the FDA had the power to regulate devices haven't begun to conduct the studies that are needed to conclusively demonstrate that they're safe, it's just too dangerous to put women at risk. What we ask for is what you described as a middle ground, a moratorium while they're being studied on widespread availability but continued access for the few women who choose them instead of saline implants after a mastectomy.

MS. BERGER: But I think that would be, I agree I think it would be a terrible travesty to do that to women and not only reconstructive patients but you have women who are healthy who come in with gross breast dosimetries. They have one breast that is very very small, a nipple, and the other one's full. All you can do is use an implant to correct it, or congenital chest deformities, and then there are women with very small breasts who need, as that woman, who need implants to enhance their self-image.

MS. WOODRUFF: Just quickly, Dr. Wolfe.

DR. WOLFE: Well, the travesty that she's talking about is nothing like the travesty that has been perpetrated by Dow and plastic surgeons on 2.3 million women, treating them as guinea pigs. That's what's gone on. And it's time for it to stop. As soon as silicone gel ban occurs safer implants will appear very, very quickly; I'm confident of that.

MS. WOODRUFF: All right. We want to thank you all for being with us. Ms. Pearson, Ms. Berger, Dr. Guy, Dr. Wolfe, thank you all. FOCUS - EQUAL EDUCATION?

MR. MacNeil: Next, does public funding for black colleges promote racial segregation? The Supreme Court took up the issue today in a case that could have a major impact on the nation's historically black universities. Nearly four decades after the court struck down separate but equal public school systems, the Justices are considering the issue for the first time in higher education. Time Magazine Reporter Julie Johnson has this report on the case before the court.

MS. JOHNSON: Jackson State University is a Southern school with a lot of brass. It's deep in the heart of Mississippi at the state capital. Its band is the sonic boom of the South. Although Jackson State is a tax-supported public school, those fancy formations on the field are executed by a student body that's almost exclusively black. Throughout the South, many state colleges and universities that once were legally segregated are still characteristically black or white. Two-thirds of Mississippi's black college students attend historically black schools. Along with the tradition of separation comes a legacy of inequality in funding, facilities, and programs. Separate but equal is a notion that the Supreme Court struck down in its landmark 1954 school desegregation decision. The Court held that separate but equal was little more than a thinly veiled rationale for a segregated system that was inherently unequal. A lawsuit now before the U.S. Supreme Court claims that biased admissions requirements still keep blacks out of the white schools. The suit demands more programs and more money to make up for years of neglect. For the past 16 years, attorney Alvin Chambliss has battled the state with this case.

ALVIN CHAMBLISS, Lawyer: The point that we're talking about is whether or not Mississippi has an obligation to educate its black citizens. The black colleges are dying and it's unfortunate I sit before you and say this to you today, the white institutions are not doing the job.

MS. JOHNSON: Homecoming weekend at the University of Mississippi, affectionately dubbed "Old Miss." The school was founded before the civil war for the children of the Mississippi aristocracy, back when college was for whites only. Nostalgic images of the Old South are still inescapable and in a state where half the high school seniors are black, fewer than 700 black undergraduates attend this university of 11,000. Elvin Knight is a student of pharmacy. He had no trouble with the admissions requirements that keep many blacks out of Old Miss. Thirty years ago that wouldn't have mattered. The stark memory of Mississippi flouted in the Supreme Court and trying to stop James Meredith from becoming the first black student at Old Miss is something many whites say is ancient history. Certainly the image in 1962, the image of Elvin Knight counseling a white student on the use of prescriptions would have been unthinkable. State legislator Ed Perry attended Old Miss during the Meredith crisis.

EDWIN PERRY, State Representative: If you had viewed it in 1962 and you could view it in 1991 from a time machine, from someone, it would be as if 1962 had never existed. You would go around the campus, you would see many minority students, I think it's several hundreds, just as if the incident had never happened.

MS. JOHNSON: That perception is not universally shared.

ELVIN KNIGHT, Student, University of Mississippi: In the school of pharmacy there are four hundred students and out of that four hundred, there are thirteen blacks. Old Miss is still Old Miss. What it was in 1962 is what it is now. To students that go to school here and black students across the state, Old Miss is still kind of a center of racism in Mississippi, if you want.

MS. JOHNSON: One of the arguments now presented in favor of all black colleges is that black students are often uncomfortable at predominantly white schools. At Old Miss, the confederate battle flag was only recently abandoned as the official school flag. Students haven't given up the stars and bars. They're a common campus image. But this is also the flag used by the Ku Klux Klan.

ELVIN KNIGHT: When you come here and you wave a flag and you're sitting next to me and there's a slag here, I think, you know, either this person's ignorant and just does not know what they're doing, or else this person knows what they're waving and they just don't care about my feelings and about how I feel about this flag.

MS. JOHNSON: Fraternities are a fixture at Old Miss. Three years ago the first black fraternity house was burned to the ground before anyone could move in. But the frat persisted and today there is one black house on fraternity row. Elvin Knight and his friend, Willie Walker, are both in fraternities. Neither of them seriously considered going to a black public college in Mississippi.

WILLIE WALKER, Student, University of Mississippi: I did not want to attend a predominantly black university because if you attend a black university you don't get exposed to all ways of life and more importantly the degree that you receive there is not too much respected.

MS. JOHNSON: For Elvin Knight, a black public college was academically out of the question.

ELVIN KNIGHT: Well, Jackson State doesn't have a pharmacy program. Actually Old Miss has the only pharmacy program in the state.

MS. JOHNSON: The scenario is the same in many fields of study. Mississippi's historically white institutions offer more courses and betterfacilities than their black counterparts. Education Prof. Ivory Phillips is president of the faculty senate at Jackson State.

IVORY PHILLIPS, Jackson State University: There's no degree in medicine, no degree in law, no degree in engineering. If you move down another level, we're talking about the lack of an advanced degree in social work, we're talking about not being able to study urban planning even at the bachelor's level and even though this is an urban university.

MS. JOHNSON: The historically black institutions were originally established to provide rudimentary vocational and teacher education. Course offerings are still extremely limited. Yet, tuition is nearly the same as at the white institutions. Ray Cleere, the state's commissioner of higher education, blames history.

RAY CLEERE, Commissioner of Higher Education: Engineering, medicine, law, the high cost prestigious programs, those programs were generally speaking located at historically white institutions in and around the turn of the century, in most cases before historically black institutions were established.

MS. JOHNSON: Cleere says that why the black schools get less money.

MR. CLEERE: That is a reflection of the mix of programs, not of disparity of funding. It costs more to educate a student in engineering than it does in history.

MR. PHILLIPS: [Talking to students] There simply needs to be more programs, better facilities and better funding at the predominantly black universities.

MS. JOHNSON: Finding supporters of the lawsuit at Jackson State is easy. Finding the money to satisfy them is not so easy. Mississippi is cutting its budget these days, not expanding. The impoverished neighborhood that borders Jackson State is a vivid reminder that this is one of the poorest states in the nation. More money for black schools would mean less money for white ones. Cleere says the state would like to give more money to the black institutions.

MR. CLEERE: I think the feeling is here, the commitment is here, but not the funding. And I don't think you could readily take that funding from other institutions.

MS. JOHNSON: The suit against Mississippi not only complains that blacks are being unfairly kept out of white colleges, it also asks for the black colleges to be upgraded as black colleges, places with their own unique heritage and traditions.

DAVID SANSING, University of Mississippi: It is, indeed, a rather strange position for the plaintiffs to take.

MS. JOHNSON: David Sansing is a professor of history at Old Miss.

MR. SANSING: The plaintiffs are actually asking for parity between the black institutions and the white institutions, which is a, it's a retrogression to separate but equal.

MS. JOHNSON: Why save black colleges?

ALVIN CHAMBLISS, Lawyer: Well, rhetorically I say why save black people? I mean, why should we exist? The, you save what is good, so this case is not just about public black colleges, but all black colleges, and I will go so far as to say black institutions, period.

MS. JOHNSON: Deciding what should be saved and how to save it is now up to the court. The ruling should be handed down around graduation time next year. RECAP

MS. WOODRUFF: Again the main stories of this Wednesday, White House and congressional leaders agreed to extend unemployment benefits, wholesale prices took their biggest monthly jump in a year. The FDA announced plans to speed up the drug approval process and tonight the House passed a bill to give many workers up to 12 weeks' unpaid leave for family emergencies. The Senate passed the bill last week. Tonight's House vote fell short of the 2/3 majority needed to override a promised Presidential veto. Good night, Robin.

MR. MacNeil: Good night, Judy. That's the NewsHour tonight and we'll see you tomorrow night. I'm Robert MacNeil. Good night.