What about all the penises?

[BoSoxGal]

I just watched Anderson Cooper’s The Whole Story episode on Johnson & Johnson baby powder and the avalanche of litigation against them by women who developed ovarian cancer. I’m sure you’ve seen the advertisements from law firms recruiting plaintiffs.

Included in the episode was the mixed and very inconclusive scientific evidence regarding whether asbestos was present in any of the talc used by J&J and whether there is any real link between talcum powder use and ovarian cancer. A representative for J&J posited the logical question - given the relative rarity of ovarian cancer versus the very widespread use of talcum powder, if the powder causes the cancer then why isn’t there an epidemic of ovarian cancer?

Now we all know BSG is not an apologist for corporate greed or corporate immorality.

But as someone who babysat many infants back in the day and changed hundreds of diapers, applying copious amounts of J&J baby powder on lots of baby genitalia and baby anuses, I can’t help but wonder- how does use of talcum powder cause ovarian cancer but not cervical cancer, penile cancer, anal cancer, testicular cancer?

I found this online:

Talcum powder and ovarian cancer

Of all the cancer concerns about talcum powder, the association with ovarian cancer appears to be the strongest.

A 2019 research review of 30 different studies found that the use of talcum powder in the perineal area (the space between the vulva and the anus) is a “possible cause” of ovarian cancer.

However, a 2020 research analysis involving more than 250,000 women in long-term health studies found “no statistically significant association” between talcum powder use in the genital area and the incidence of ovarian cancer.

The American Cancer Society (ACS) suggests that because ovarian cancer is somewhat uncommon, even large studies may not be able to detect slight risk increases.

Is there something I’m missing? How does baby powder cause cancer in ovaries, but bypasses the cervix and uterus to get there? How does it not cause penises and testicles and anuses to get rotten with cancer?

[Joe Guy]

As I understand it, when it comes to science, it doesn't really matter what the truth is, it's whether or not you can convince a jury that it's true.

[Burning Petard]

As I understand it, J&J has marketed a product generally called 'baby powder' for many decades and it has a long history of use without substantiated indication of any problem. However, in recent times they changed the source and mix of raw materials used in this product and those changes are posited as the cause of the cancer.

snailgate

[BoSoxGal]

As I understand it, J&J has marketed a product generally called 'baby powder' for many decades and it has a long history of use without substantiated indication of any problem. However, in recent times they changed the source and mix of raw materials used in this product and those changes are posited as the cause of the cancer.

snailgate

That assertion is not supported by the reporting I just watched.

They presented the evidence that J&J has been producing the same talcum powder product for 130 years and sourcing the talc from various mines.

Recently in North America and Europe they switched to a cornstarch formulation because of the lawsuits, but they are still selling talcum all over the globe.

Online I found a source saying they have plans to phase out the talcum entirely by the end of this year, but it wasn’t a J&J website, so I don’t know if it is true.

[Sue U]

I did asbestos litigation for 20 years and am familiar with the talc cases; it's a long story but the short version is that the talc J&J was sourcing was contaminated with tremolite asbestos, which if it gets past the body's defenses can lodge in certain types of tissues and cause cancer. Some tissues are more hospitable to and more sensitive to the fibers than others. And like inhaled asbestos, it is not a given that exposure *will* cause cancer, or that any cancer would be detected, or that a cancer once detected would necessarily be causally associated with talc use by a diagnosing physician. There are NIH studies showing a very significant increase in ovarian cancer with regular talcum powder use. I'll post links to explanatory materials tomorrow but right now it's late and I have to get up early.

[ex-khobar Andy]

I'll wait to see the tech stuff that Sue posts but I am not personally convinced that asbestos causes cancers other than, obviously, mesothelioma - and even that seems to be confined largely to those who had a great exposure, e.g., shipyard workers and the like. Equally, and to answer BSG's question, every cancer is different and just because penises, testicles, anuses, cervixes and uteri all share a common space with ovaries does not mean that these cancers necessarily share a common cause.

In 1984 I did an asbestos testing course at Temple University in Philadelphia. In those days EPA had two accepted tests: airborne asbestos which was basically a microscope procedure looking for fibers of the right sort of aspect ratio and size - human hairs are just way too thick for consideration; and bulk asbestos testing in materials such as insulation, vinyl tile, talc and so on. The bulk testing used polarized light microscopy (PLM) which is a common test for minerals. Basically the suspect mineral fiber is soaked in a polarizing liquid of a known refractive index and the interaction between the liquid and the mineral is studied under the microscope. I'm quite color blind and there is no way I can properly judge these interactions so I did not do that course. In later years EPA adopted a transmission electron microscopy (TEM) test for bulk asbestos - this is much less subjective: the TEM can identify elements present in the fiber. But a PLM costs maybe $2000 and a TEM $100,000 (1980s prices). The TEM test, because it is less subjective, is more appropriate for routine testing but the PLM test when carried out by someone with great experience who really knows what s/he is doing is still an excellent test.

Talcum powder can contain associated asbestos fibers - tremolite as Sue said but commonly also anthophyllite and occasionally chrysotile. These are all different fiber types of asbestos. To me the bigger danger of talcum powder is that breathing it can cause mesothelioma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164883/

[BoSoxGal]

To me the bigger danger of talcum powder is that breathing it can cause mesothelioma. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4164883/

This is a scary thing to read with my morning coffee this morning.

Did I mention how proud I was to get my Girl Scout babysitting badge at 11? I started babysitting the next door neighbor's little girl, still in diapers, at 11 - my mom was right next door if I needed help. By age 12 I was babysitting every single weekend and occasionally a few hours on a week night and had several families fighting over my time. I cut way back at age 15 to spend time with friends and in extracurricular activities, but for 4 years in my youth I breathed clouds of baby powder on a regular basis.

[Sue U]

I think a critical consideration in the talc cases is whether the talc was or was likely to have been contaminated with asbestos. Some talcum powders were/are in fact asbestos-free, whether through intentional purification or dumb luck. Other "baby powder" formulations (including J&J's) simply don't use talc at all.

Cramer, et al., The Association Between Talc Use and Ovarian Cancer, Epidemiology, May 2016

Taher, et al., Critical review of the association between perineal use of talc powder and risk of ovarian cancer, Reproductive Toxicology, December 2019

Moline, et al., Moline, et al., Mesothelioma Associated With the Use of Cosmetic Talc, Journal of Occupational and Environmental Medicine, January 2020

Reuters: Johnson & Johnson knew for decades that asbestos lurked in its Baby Powder, 14 Dec. 2018

I'll wait to see the tech stuff that Sue posts but I am not personally convinced that asbestos causes cancers other than, obviously, mesothelioma - and even that seems to be confined largely to those who had a great exposure, e.g., shipyard workers and the like.

It is simply not true that cancers are "confined largely to those who had a great exposure." I have personally prosecuted a number of mesothelioma cases resulting from "secondary" or "household" exposures, particularly in the wives of refinery, chemical plant and shipyard workers who laundered the dust-covered work clothing of their husbands. The science actually shows that depending on fiber type, even small exposures to asbestos can result in mesothelioma. And all types of asbestos have a synergistic effect with smoking in producing lung cancers (i.e., cancers other than mesothelioma, which is in the tissues surrounding the lungs). Substantial exposures to chrysotile asbestos over time will produce pleural thickening and asbestosis, which although "non-malignant" can progress to debilitating and even fatal disease, along with being a marker or risk factor for cancers, which can have a latency period of decades.

As I understand it, when it comes to science, it doesn't really matter what the truth is, it's whether or not you can convince a jury that it's true.

This is utter bullshit and these kinds of attitudes are the direct result of "tort reform" propaganda campaigns run by manufacturers of hazardous products and their allies in the US Chamber of Commerce. The standard for admissibility of scientific evidence at trial is actually quite high (see Daubert v. Merrell Dow Pharmaceuticals Inc., 509 U.S. 579 (1993)) and is often the subject of "mini-trials" to ensure its validity long before any case ever actually gets in front of a jury. It has actually become a problem where the scientific literature has not yet sufficiently caught up to explaining the causation/mechanism of injury that is readily observable in statistical data.

[Big RR]

not only that, but development of cancer from exposure to known carcinogens is rarely a simple process. True, the greater the exposure, the higher the chances of developing it, but most of us know people who lived well into their 80s and 90s despite being heavy smokers and others who develop it from far less exposure over a shorter time. Why? Who knows for certain? some people just appear to be resistant to developing these diseases and, even among those who are not resistant, it is hardly a certainty that complications will develop--it's all statistical, and you may win or lose. So it's not surprising that many people having high exposure to asbestos have a greater chance of developing mesothelioma (but some do not), while others having exposure at far lower levels develop problems. Time also is a factor, as persistent exposure creates an increased tendency to develop the disease. But the point is this, if exposure to a substance is a known danger (like exposure to asbestos is), care should be taken to reduce or eliminate entirely that exposure--especially when you are selling a product for use with infants--it's not call "Baby Powder" for nothing. And willfully (or negligently) ignoring that danger to make a profit should create some right to compensation for the victim(s).

Or, Joe Guy, do you have a reason to dispute this?

[Joe Guy]

Or, Joe Guy, do you have a reason to dispute this?

I agree with everything you wrote. I'm not even disagreeing with the idea that J&J talcum powder may cause cancer. My point is simply that a jury decides liability in these cases and as far as I know, jurors in these types of cases are not required to be toxicologists, epidemiologists or even cancer patients.

OJ Simpson probably agrees with me.

[ex-khobar Andy]

Which, BTW, is why I said 'largely' and certainly wives of shipyard workers who washed their husband's asbestos laden overalls would be included in my 'great exposure' cohort. Looking again at what I wrote it's a bit of a casualty of editing down because of course there are other cancers caused by asbestos. But we did spend a ton of time and money in the 80s and 90s under AHERA (Asbestos Hazard Emergency Response Act) remediating asbestos from situations such as encased in vinyl tile where it was probably safe enough. Yes it's a bad idea; don't do it again; but spend your treasure elsewhere on some real and not imagined dangers.

Daubert. I wondered when we would get to Daubert. Very laudable idea, that judges should consider the admissibility of scientific evidence based on some reasonable criteria such as peer review and publication etc. On my bedside reading pile is "Junk Science and the American Criminal Justice System" by M. Chris Fabricant. Fabricant's bête noir is forensic odontology - the so-called scientific matching of teeth marks, perhaps in a corpse, to the teeth of the supposed perpetrator. It certainly has a veneer of plausibility - a gap in the scar might correspond to a missing molar in the perp - but it has been way oversold by those dentists who call themselves forensic odontists and who have created their own certification system and so on. It is not unreasonable to suppose that the going rate for expert witnesses might be a factor in these good dentists' willingness to describe their 'skill' as based on science, reason, logic and common sense. But among people who have actually studied it the science is definitely not settled although many judges , despite Daubert, still seem to think that it is.

A 2007 NYT story said:

In spite of the evolution of other forensic sciences, bite-mark analysis remains an inexact tool. A 1999 study by a member of the American Board of Forensic Odontology, a professional trade organization, found a 63 percent rate of false identifications.

(Daubert was decided in 1993.). Nevertheless, forensic odontology continues to be accepted by 'gatekeeper' judges.

It's part of a larger problem. As a scientist I am used to saying 'trust the science.' I should rephrase that: 'trust good science carried out by good scientists.' Forensic science in particular needs far more than a cursory examination; and way too many 'scientists' who think they can match hairs or blood spatter or bullet markings are no better than the police who smell weed every time they make a traffic stop.

I've lost clients - good clients with $$$$ - because my lab results did not correspond to what they thought the results should be. Tough shit. I could back up my data all the way and we repeated tests at our own expense if the results were off the wall. Most scientists won't acknowledge this but - especially as a low grad student and I am speaking from personal experience here - when you get a result which goes against scientific orthodoxy one's first thought is not 'Stockholm here I come!' but 'What am I doing wrong?'. (One day I'll tell you the story of the $250,000 pizza boxes.)

I've gone on far longer than I had intended. I like Daubert - much needed and certainly a step in the right direction. But most judges are not equipped to discriminate between good science and bad. And a judge might, in the attempt to be a disinterested referee (aka gatekeeper) let the scientists fight it out. If that means giving equal time to flat earthers and Eratosthenes who figured it out 2500 years ago - no thanks.

[Big RR]

Or, Joe Guy, do you have a reason to dispute this?

I agree with everything you wrote. I'm not even disagreeing with the idea that J&J talcum powder may cause cancer. My point is simply that a jury decides liability in these cases and as far as I know, jurors in these types of cases are not required to be toxicologists, epidemiologists or even cancer patients.

OJ Simpson probably agrees with me.

Point taken Joe, it doesn't always always work the way we would like, but that is how an adversarial system works; both sides are free to use scientifically qualified experts to attack the evidence and contentions of the other side. But I have seen it work remarkable, even in some cases based very much on complicated science. Most jurors want to do a good job and are willing to be educated, and often can sort through the bullshit far more often that the scientists can (looking how easily "scientists" could be bamboozled by "experiments" orchestrated by so-called psychics (mainly because those psychics understand how scientists think and can easily use this to their advantage). Common sense is not always common, but I have seen it many times with juries.

And FWIW, there are a lot of reasons the OJ verdict turned out the way it did, science among them, but I think the jurors were far more convinced that OJ was being framed by the police than by some sort of spooky science. It may not be common sense, but the mistrust of the police is fairly common, especially among the LA jury pool.

[Sue U]

Looking again at what I wrote it's a bit of a casualty of editing down because of course there are other cancers caused by asbestos. But we did spend a ton of time and money in the 80s and 90s under AHERA (Asbestos Hazard Emergency Response Act) remediating asbestos from situations such as encased in vinyl tile where it was probably safe enough. Yes it's a bad idea; don't do it again; but spend your treasure elsewhere on some real and not imagined dangers.

When we bought our current house I immediately recognized the floor tile in the basement as Kentile "Carnival" vinyl-asbestos tile (14% asbestos). I was okay with leaving it in place, but a minor flood loosened and cracked the tiles and we had to take them up, which we did ourselves. I judged it to be pretty low risk since we kept it wet and used high-quality respiratory protection. (However, If I do develop mesothelioma in the next decade or two, that will be a likely cause.) But for a not-insignificant number of people who worked in the building trades and flooring industry, cutting and sanding and scraping asbestos tile and mastic did produce enough dust to cause or contribute to some very nasty cancers. I have seen more than a few mesothelioma deaths -- even had one client die during his deposition -- it is not the way I'd want to go.

Daubert. I wondered when we would get to Daubert. Very laudable idea, that judges should consider the admissibility of scientific evidence based on some reasonable criteria such as peer review and publication etc. On my bedside reading pile is "Junk Science and the American Criminal Justice System" by M. Chris Fabricant. Fabricant's bête noir is forensic odontology - the so-called scientific matching of teeth marks, perhaps in a corpse, to the teeth of the supposed perpetrator. It certainly has a veneer of plausibility - a gap in the scar might correspond to a missing molar in the perp - but it has been way oversold by those dentists who call themselves forensic odontists and who have created their own certification system and so on. It is not unreasonable to suppose that the going rate for expert witnesses might be a factor in these good dentists' willingness to describe their 'skill' as based on science, reason, logic and common sense. But among people who have actually studied it the science is definitely not settled although many judges , despite Daubert, still seem to think that it is.

Of course, industrial epidemiology, forensic pathology identifying ferruginous bodies and actual asbestos fibers in cancer tumors, electron microscope analysis of materials, decades of multidisciplinary occupational health studies/risk analyses and the asbestos products manufacturers' own investigations of product safety dating to the 1930s are hardly the equivalent to the at-best fuzzy "science" of bite marks. Maybe at some point in the near future "forensic odontology" will be treated the same way as polygraph testing -- generally inadmissible unless the parties agree that it is actually probative of some issue, on a case-by-case basis. But even low-value science might shed some light on a contested issue of fact, and it is the judge's job to make sure the methodology is sound and the basic science generally accepted by actual experts in the relevant field -- which is often accomplished with "science day" proceedings to first educate the court, followed by hearings to determine whether and what kind of expert testimony ought to be admitted in trying the case itself. Both the proponents and opponents of the proposed scientific evidence participate, and It is not a haphazard or cursory -- or inexpensive --process. The costs of presenting scientific evidence alone are enough to dissuade a substantial amount of so-called "junk science" from getting anywhere near a courtroom, and I have seen "legally" inadequate science sink otherwise promising large-scale litigation (e.g., Accutane). In my experience, it has never been an issue of "giving equal time to flat earthers and Eratosthenes."

[Big RR]

Sue--re the "Science Day" proceedings, I have also seen times where the court will appoint a special master (usually a scientifically trained person) to aid in the review. I have seen detailed masters reports prepared which talk about methodology and the scientific validity.

[Jarlaxle]

Which, BTW, is why I said 'largely' and certainly wives of shipyard workers who washed their husband's asbestos laden overalls would be included in my 'great exposure' cohort. Looking again at what I wrote it's a bit of a casualty of editing down because of course there are other cancers caused by asbestos. But we did spend a ton of time and money in the 80s and 90s under AHERA (Asbestos Hazard Emergency Response Act) remediating asbestos from situations such as encased in vinyl tile where it was probably safe enough. Yes it's a bad idea; don't do it again; but spend your treasure elsewhere on some real and not imagined dangers.

Daubert. I wondered when we would get to Daubert. Very laudable idea, that judges should consider the admissibility of scientific evidence based on some reasonable criteria such as peer review and publication etc. On my bedside reading pile is "Junk Science and the American Criminal Justice System" by M. Chris Fabricant. Fabricant's bête noir is forensic odontology - the so-called scientific matching of teeth marks, perhaps in a corpse, to the teeth of the supposed perpetrator. It certainly has a veneer of plausibility - a gap in the scar might correspond to a missing molar in the perp - but it has been way oversold by those dentists who call themselves forensic odontists and who have created their own certification system and so on. It is not unreasonable to suppose that the going rate for expert witnesses might be a factor in these good dentists' willingness to describe their 'skill' as based on science, reason, logic and common sense. But among people who have actually studied it the science is definitely not settled although many judges , despite Daubert, still seem to think that it is.

A 2007 NYT story said:

In spite of the evolution of other forensic sciences, bite-mark analysis remains an inexact tool. A 1999 study by a member of the American Board of Forensic Odontology, a professional trade organization, found a 63 percent rate of false identifications.

(Daubert was decided in 1993.). Nevertheless, forensic odontology continues to be accepted by 'gatekeeper' judges.

It's part of a larger problem. As a scientist I am used to saying 'trust the science.' I should rephrase that: 'trust good science carried out by good scientists.' Forensic science in particular needs far more than a cursory examination; and way too many 'scientists' who think they can match hairs or blood spatter or bullet markings are no better than the police who smell weed every time they make a traffic stop.

I've lost clients - good clients with $$$$ - because my lab results did not correspond to what they thought the results should be. Tough shit. I could back up my data all the way and we repeated tests at our own expense if the results were off the wall. Most scientists won't acknowledge this but - especially as a low grad student and I am speaking from personal experience here - when you get a result which goes against scientific orthodoxy one's first thought is not 'Stockholm here I come!' but 'What am I doing wrong?'. (One day I'll tell you the story of the $250,000 pizza boxes.)

I've gone on far longer than I had intended. I like Daubert - much needed and certainly a step in the right direction. But most judges are not equipped to discriminate between good science and bad. And a judge might, in the attempt to be a disinterested referee (aka gatekeeper) let the scientists fight it out. If that means giving equal time to flat earthers and Eratosthenes who figured it out 2500 years ago - no thanks.

Spot on. There is plenty of junk science that has been accepted by courts. (Off the top of my head, ballistic "fingerprinting" is a CSI fantasy.)