Talcum powder's links to ovarian cancer: What it really means

Story highlights

  • Ford Vox: Johnson & Johnson loses talcum powder lawsuit
  • He says it shouldn't be a jury's job to weigh link between talcum powder and cancer
  • Vox: Johnson & Johnson, feds should keep up with effects of all consumer products

Ford Vox is a physician specializing in rehabilitation medicine and a journalist. He is a medical analyst for NPR station WABE-FM 90.1 in Atlanta. He writes frequently for CNN Opinion. Follow him on Twitter @FordVox. The opinions expressed in this commentary are solely those of the author.

(CNN)Does talcum powder — powder that many have slathered on babies for generations -- really cause cancer?

There are more than 1,000 women lined up to sue Johnson & Johnson over just that: cancer diagnoses they attribute to the company's talcum powder products.
    On Monday, a St. Louis jury ordered the company to pay $55 million to a South Dakota woman who had used talcum powder for years and has ovarian cancer.
    But why did it take rainmaker attorneys to educate a jury from square one all the way to the point of ringing up a jackpot verdict? Johnson & Johnson positioned itself well as their target: Even though scientists have been publishing concerning studies for years, the company didn't forthrightly warn its customers there could be a major safety issue.
    Talcum powder also managed to escape the oversight of federal agencies many consumers might imagine are always on high alert, surveilling the published literature for product safety concerns.
    So what's the big problem with a product millions of people have considered so safe they put it on babies during diaper change?
    The theory is that talcum powder, when applied in the genital region, manages to work its way up through the vagina, the cervix, the uterus, the fallopian tubes and into the ovaries.
    The female reproductive system has, after all, evolved to facilitate the upward mobility of sperm in order to fertilize eggs that have descended into the uterus, and the microscopic particles of talcum powder may well keep traveling all the way up.
    Indeed, doctors have identified talc particles inside cancerous ovarian tissue. Talc has also been found in pelvic lymph nodes, indicating that it made it all the way out of the fallopian tubes and into the abdominal space.
    Mom and 14-year-old daughter battle cancer
    pkg mom daughter battle cancer_00012104

      JUST WATCHED

      Mom and 14-year-old daughter battle cancer

    MUST WATCH

    Mom and 14-year-old daughter battle cancer 02:16
    In 2013, Deane Berg of Sioux Falls, South Dakota, was the first woman diagnosed with ovarian cancer to take on the medical and consumer products giant.
    She came away without a dime awarded to her even though she won her suit; instead of awarding monetary damages the jury told Johnson & Johnson that it should affix a warning to its talc products like Johnson's Baby Powder and Shower to Shower, one that says the product could cause cancer.
    And Berg's lawsuit laid historic legal groundwork: The company will now have to pay a combined $127 million in damages awarded in two cases by St. Louis juries this year if its appeals aren't successful.
    In the Berg lawsuit, Brigham and Women's Hospital obstetrician and gynecologist Dr. Daniel Cramer testified to his opinion that upwards of 10,000 women a year are developing ovarian cancer in part due to their use of talcum powder.
    Pathologist Dr. John Godleski, also at Brigham, found talc particles inside Berg's ovarian tumor tissue.
    I don't have records from the two St. Louis cases where juries have penalized Johnson & Johnson with megamillion-dollar awards to the plaintiffs, but I'd expect those juries saw similar evidence to what Berg presented in 2013.
    Dogs used to sniff out ovarian cancer
    Dogs used to sniff out ovarian cancer

      JUST WATCHED

      Dogs used to sniff out ovarian cancer

    MUST WATCH

    Dogs used to sniff out ovarian cancer 01:23
    In fact, Cramer and his colleagues at Brigham just published a large study looking back at over 2,000 women diagnosed with ovarian cancer and comparing their use of talcum powder with that of a similar group of women who didn't have ovarian cancer.
    In showing a strong link between talc use and ovarian cancer, a 33% higher risk overall, the Brigham group specifically faulted another large study published in 2014 that didn't identify a risk. That study, Cramer wrote, didn't look at premenopausal women who seem to be at higher risk, and didn't properly weigh the role of estrogen use, which seems to be a necessary ingredient in upping the risk for ovarian cancer in postmenopausal women.
    The medical debate over whether talcum powder causes ovarian cancer goes back many decades, and the attorneys in these cases are demonstrating, through internal documents they've subpoenaed, that Johnson & Johnson knew about this research.
    They allege that Johnson & Johnson is akin to the tobacco companies that knew about research linking smoking to lung cancer but kept this information from the public and fought off attempts to regulate their product.
    I don't think Johnson & Johnson deserves quite the opprobrium we reserve for the tobacco companies, since conflicting research did exist, but they and companies like them are setting themselves up for these kinds of lawsuits if they're not open and transparent with consumers.
    CNN archives: Jolie on her mom's cancer
    CNN archives: Jolie on her mom's cancer

      JUST WATCHED

      CNN archives: Jolie on her mom's cancer

    MUST WATCH

    CNN archives: Jolie on her mom's cancer 00:59
    A smarter approach would have been to acknowledge the worrisome research studies in their consumer literature, on their websites, and to have flagged customers somehow on their product labeling to review this material with their doctors and decide for themselves whether and how to use the products.
    But it's not all Johnson & Johnson's responsibility. Federal agencies like the Food and Drug Administration, the Centers for Disease Control and Prevention and the Consumer Products Safety Commission need the authority and the funding to keep up with reported and published adverse effects of all consumer products, and actively weigh when mandatory warnings are necessary.
    Companies should welcome the federal agencies taking off some of the load -- Johnson & Johnson could have shared some of its liability with such an agency by regularly checking in about how it should act, or what warning it should issue, in light of recent research.
    We have a problem when it falls to trial juries to weigh the scientific data on a given product against a particular medical case and decide whether a company should be adding warning labels, or paying out large sums in the hopes the companies will learn a lesson.
    That's one way to get the job done, but it's after the fact, it's messy, and it's prone to error and excess. We can expect that appeals will significantly reduce these headline-grabbing jury awards.