J&J Must Pay $72 Million in Talc Powder-Ovarian Cancer Case

Nick Mulcahy

February 23, 2016

A St. Louis jury has awarded $72 million to the family of a woman who died of ovarian cancer and said that her long-time use of Johnson & Johnson talc powder products contributed to her cancer. The jury decision is the first financial award in a lawsuit related to this issue.

The state-court jury ordered the giant maker of healthcare products to pay $10 million in compensatory damages and $62 million in a punishment award to the family of Jackie Fox from Birmingham, Alabama.

Fox died in October 2015 at the age of 62, 3 years after being diagnosed with ovarian cancer. Shortly before her death, she recorded an audio deposition, saying she had used Johnson & Johnson talc powder products for 35 years, according to a report in the St. Louis Post-Dispatch.

The news puts a spotlight again on the association between the use of talc powder in the genital area and an increased risk for ovarian cancer, which has been repeatedly — but not always — found in epidemiologic studies.

However, the only consensus among researchers and organizations such as the International Agency for Research on Cancer on the link is that talc powder is a "possible" carcinogen (Lancet Oncol. 2006;7:295-296).

"This is probably not going to be decided in the court of scientific opinion. It will be decided in the court of legal opinion," Daniel Cramer, MD, ScD, an obstetrician/gynecologist at Brigham and Women's Hospital in Boston and a prominent researcher on the subject, told Medscape Medical News last week.

In 1982, Dr Cramer was the lead author of the first study ever to link talc use with ovarian cancer. He has since been involved in multiple studies on the association, the latest of which was published just a few months ago (Epidemiology. Published online December 17, 2015). He also testified at the Johnson & Johnson trial as a paid expert witness.

"I'm still absorbing the news," Dr Cramer said today. "A feeling of vindication is tempered by the realization that thousands of women continued to use talc products and died of ovarian cancer after my first study in 1982."

"You can count on J&J to appeal the verdict, but the scientific case is only going to get stronger," he said.

But not everyone agrees with that assessment.

In a 2014 essay, Robert Coleman, MD, a gynecologic oncologist at the University of Texas M.D. Anderson Cancer Center in Houston, made the analogy that talc powder is the "Pluto" of prognostic factors for ovarian cancer.

"When we all grew up, Pluto was a planet (analogy: talc was thought to be a causative risk factor in almost every textbook); then, a few years ago, after better data emerged, Pluto lost its status as planet (analogy: newer and better controlled studies demonstrated that talc exposure is probably not a true risk factor)," he explained to Medscape Medical News in an email.

However, Dr Cramer states that the preponderance of evidence indicates that there is a link between talc use in the genital area and an increased risk for ovarian cancer.

According to an American Cancer Society report, more research is needed, but "if there is an increased risk, the overall increase is likely to very be small."

Karin Roseblatt, PhD, a public health professor at the University of Illinois at Urbana-Champaign, who was involved in a case–control study on this subject (Cancer Causes Control. 2011;22:737-742), believes that any risk is "not a very high increased risk."

"I can't say for sure if it is a definite risk," she told Medscape Medical News.

But, according to news reports, the jury in St. Louis found Johnson & Johnson guilty of failing to warn the public and conspiring to keep the truth about the possible link from the public for decades.

Jury foreperson Krista Smith said that the company's internal documents were "decisive" for jurors, according to a Bloomberg news story.

"It was really clear they were hiding something," said Smith. "All they had to do was put a warning label on."

Johnson & Johnson is reportedly facing about 1200 suits related to Johnson's Baby Powder and its Shower to Shower products.

The Shower to Shower brand talc was marketed for "feminine hygiene" and had used the advertising slogan that "just a sprinkle a day keeps odor away."

Valeant Pharmaceuticals bought the Shower to Shower brand from Johnson & Johnson in 2012, but was not a defendant in the St. Louis case.

Johnson & Johnson does not have a press statement about the jury's verdict on its website. However, spokesperson Carol Goodrich was quoted in a news report as saying: "We sympathize with the plaintiff's family but firmly believe the safety of cosmetic talc is supported by decades of scientific evidence."

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