Pamela A. Popper, Ph.D., N.D.
Wellness Forum Health
A recent jury verdict is representative of the confusion about the connection between chemicals and cancer. A jury awarded the family of Jackie Fox $72 million to be paid by defendant Johnson and Johnson because she died of ovarian cancer after using a talc-based hygiene powder. The attorney who represented Fox’s family says that J&J should either remove talc from its products or include a warning label describing the increased risk of ovarian cancer. Both sides are sure they are right as Fox’s family is convinced the talc-based product killed her, and J&J says there is no connection between the use of its talc-based product and her death from ovarian cancer.
I’ve decided to cover this particular case because the issues contributing to it are common and cause much public confusion. Starting with the assumption that chemicals are harmful, a hypothesis is put forth that a chemical causes cancer. Research studies follow, and some studies show a connection while others do not. Poorly constructed animal research and observational studies are often cited to support the connection between the chemical and cancer. Small increases in risk are reported in relative rather than absolute terms which makes them seem much more important than they really are. Reporters start writing stories about the connection between the chemical and cancer, usually reporting the overblown risk level because they do not know better. “Open-minded” health professionals start talking about the newly discovered risk, and warning their patients that they should avoid exposure to the chemical. As the issue becomes more public, the family of someone who died determines that exposure to this chemical killed their loved one, finds a plaintiff’s lawyer to sue the manufacturer, who hires “experts” who testify that the connection is real, a sympathetic jury decides in favor of the plaintiff, it becomes headline news, and everyone “knows” the chemical causes cancer.
To be clear, I support our current legal system with all of its messiness and excessive verdicts. The percentage of cases in which excessive verdicts are awarded is very small, and the only way to teach some bad actors such as cigarette manufacturers and drug companies a lesson is to hurt them financially. Most harmed plaintiffs don’t have enough money to pay an attorney, so allowing lawyers to take a percentage of the award in order to finance a legal action is the only way many people can get justice. So this will not be an article about reforming the legal system. Instead, I’ll address other issues, because the role lawyers play in these scenarios is actually quite small.
Based on the size of this verdict, you might think that the connection between talc and ovarian cancer is quite clear, and the increased risk from use is significant. However, that is not the case.
The first study that showed a relationship between talc use and ovarian cancer was published in 1982, and involved 215 women with ovarian cancer and 215 controls. While this study was offered as proof that there was a likely connection between talc use and ovarian cancer risk, it hardly made a strong case as 92 women with ovarian cancer reported using talc regularly, but so did 61 of the controls.[i] Other studies showed a connection between talc use and ovarian cancer, but many, like this one, showed a weak association, some showed no association[ii] [iii], and the results of several were not statistically significant.[iv]
One of the problems with research on this issue is research methodology. Case control studies rely on self-reported data, which is often unreliable. Women who have cancer are more likely to report exposure to substances they think might be hazardous, and over-report use or exposure. It is also difficult to control for the almost unlimited variables that can contribute to cancer, such as diet and lifestyle habits.
One research group, in an effort to overcome these limitations, conducted a prospective study of the risk of perineal talc use part of the Nurses’ Health Study, which included over 121,000 women. The group concluded that there was no association between the use of talc and epithelial ovarian cancer, no increased risk as a result of daily perineal talc use, and no increased risk of ovarian cancer as a result of increased use. The use of talc on sanitary napkins lowered risk, but the association was not statistically significant. When women who used both perineal talc and talc on sanitary napkins were compared to never users of talc, no effect was noted. There was a very small, less than 1.0%, increased risk of serous invasive cancers for talc users. The hypothesis for how talc might cause ovarian cancer is that the fibers migrate through a woman’s genital tract to the ovaries. But the researchers found that risk was not lower for women who had a tubal ligation.[v]
Additionally, there is no known mechanism of action for how talc can increase the risk of ovarian cancer. Research on animals, while not always applicable to humans, has not shown definitive results either. The bottom line is that, at least at this time, there is no conclusive evidence linking talc use to increased risk of ovarian cancer.
Daniel Cramer, an epidemiologist at Brigham and Women’s Hospital, has conducted research in this area, none of which has conclusively shown that talc use increases the risk of ovarian cancer. He says that the mechanism of action may have to do with inflammation, and that “It will be nice if we can put together an animal experiment to prove it.”[vi] Lack of proof has not stopped Cramer from being a paid consultant to plaintiff’s lawyers for talc litigation. And lack of proof has not dampened enthusiasm for more lawsuits as there are hundreds more pending based on the allegation that talc use causes ovarian cancer.
Who’s at fault in this debacle? There are many systems and organizations that contribute to messes like this one. The focus on reductionism by both researchers and funding agencies, including the federal government, has resulted in thousands of research studies looking for single causes for complicated health issues. Even if a proven connection between talc use and ovarian cancer, along with a mechanism of action, is discovered, this will not mean that by itself, talc causes ovarian cancer. There are many factors that increase cancer risk, and it is a combination of many of these factors that causes cancer in humans.
Advocacy groups and consumer organizations are also to blame. While I’m sure these groups are well-intentioned, they continue to promote the idea that chemicals in plastic bottles, cans, and personal care products are a major risk factor for cancer. It may be unpopular to say this, but research simply does not support this idea. Choose almost any chemical and read journal articles reporting study results, and you will see the same hypothesizing, exaggerated, inconclusive, and conflicting results that are reflected in the talc-ovarian cancer issue. This constant fear-mongering distracts from the known and proven risk factors for conditions like ovarian cancer, which include weight status, and diet and lifestyle habits.
While it is fashionable to blame trial lawyers, and I’ll admit there are some bad ones, they could not file cases like the Fox case without the assistance of scientists for hire, like Daniel Cramer. Trial lawyers cannot be expected to know about risk factors for cancer, so they hire “experts” like Cramer. While acknowledging that the connection between talc and ovarian cancer is far from proven, he lends credibility to the claim and helps to convince juries who are equally uneducated about scientific research.
In the meantime, my prediction is that the Fox family will never receive $72 million. The case will spend a very long time working its way through the appellate courts, and may get settled for a much smaller sum when both the family and J&J get tired of fighting. Some of the remaining cases will be won, some lost, which will just add to the confusion. But here is what we can count on, higher prices the next time we purchase J&J products like Bandaids, since litigation is a cost of doing business that must be factored into the cost of goods sold.
[i] Cramer D, Welch W, Scully R, Wojciechowski C. “Ovarian cancer and talc: a casecontrol study.” Cancer 1982;50:372-
[ii] Whittemore A, Wu M, Paffenbarger R et al. “Personal and environmental characteristics related to epithelial ovarian cancer. II. Exposures to talcum powder, tobacco, alcohol, and coffee.” Am J Epidemiol 1988;128:1228-40.
[iii] Tzonou A, Polychronopoulou A, Hsieh C, Rebelakos A, Karakatsani A, Trichopoulos D. “Hair dyes, analgesics, tranquilizers and perineal talc application as risk factors for ovarian cancer.” Int J Cancer 1993;55:508-10
[iv] Chen Y, Wu P, Lang J, Ge W, Hartge P, Brinton L.”Risk factors for epithelial ovarian cancer in Beijing, China.” Int J Epidemiol 1992;21:23-9.
[v] Gertig D, Hunter D, Cramer D. et al. “Prospective Study of Talc Use and Ovarian Cancer.” JNCI J Natl Cancer Inst 2000;92(3):249-252.
[vi] Kerry Grens. “Can Talc Cause Cancer?” The Scientist March 2, 2016