ST. LOUIS – In the final week of trial alleging Johnson & Johnson baby powder caused 22 women to develop ovarian cancer, the defense again fought back that the disease came from other causes, while the plaintiffs’ attorney said the defendants were dodging the truth.
“Everything you’re putting up there is all circumstantial,” Dr. Kevin Holcomb, a New York gynecology oncologist with Weill Cornell Medicine, told the attorney for the plaintiffs, Mark Lanier.
“It’s circumstantial by people who have spent a lot of time studying asbestos as opposed to you, who had zoned in on it since you were hired (by J&J) in January of this year,” Lanier responded.
Holcomb appeared as a defense witness by live video screen in the courtroom because he was unable to attend the trial in person. The month-long trial in the St. Louis City Circuit Court is being streamed courtesy of Courtroom View Network.
Lisa Simpson, attorney for Johnson & Johnson, asked Holcomb about his observations on some of the women plaintiffs after reviewing their medical records, personal fact sheets and pathology reports. Of the original 22 plaintiffs, six died before the start of the trial.
Holcomb said the first thing patients want to know after a cancer diagnosis is how they acquired it.
“Very often they’re looking for somebody to blame,” he said. “In most of their cases it was nothing they did personally.”
“Did they ever ask you if talcum powder caused their ovarian cancer?” Simpson asked.
“Increasingly over time they have,” Holcomb answered. “It’s something that is well known in the lay media at this point.”
“What did you tell them?” Simpson asked.
“I explain to them it (talc) is not something that increases the risk of ovarian cancer,” Holcomb said. “The data does not support it.”
Medical charts projected for the jury displayed photos of the plaintiffs and recounted their medical conditions. Sheila Brooks, Carole Williams and Annie Grover had high grade carcinomas. Olga Salazar had a low-grade carcinoma while Johanna Goldman had what was titled a “poorly differentiated adenocarcinoma (esophageal cancer).”
Goldman died last year.
“Low grade is different from high grade, the treatment is also different,” Holcomb explained.
“Would it make sense to you for talcum powder to cause cancer in all these types?” Simpson asked.
“No, it’s unlikely one type of exposure caused these,” Holcomb said.
Holcomb said doctors routinely use talc powder to treat patients who have fluids in their lungs, a condition called pleural effusion.
“This has gone on for years,” he said. “If we thought it (talc) caused cancer, it would be unethical.”
Under cross-examination Lanier questioned Holcomb’s expertise in the study of asbestos.
“You had a very limited knowledge about asbestos before Johnson & Johnson hired you in this case, is that fair to say?” he asked.
“That’s fair to say,” Holcomb said.
“You didn’t even know there were different types of asbestos,” Lanier said.
“That’s true,” Holcomb responded.
“You had no real knowledge about how asbestos might reach the ovaries,” Lanier said.
“That’s fair,” Holcomb agreed.
Lanier and Holcomb agreed there are about 25,000 yearly cases of ovarian cancer in the U.S. while the number of mesothelioma cases numbers about 2,000. The chance of survival with ovarian cancer is about 10 percent in stage IV of the disease, 30 percent with stage III.
The chance of surviving mesothelioma is zero.
“You said of talc, why would we use it in pleural effusion (lung fluid buildup), lung stuff, did I hear you right?” Lanier asked.
“You did,” Holcomb answered.
“Do you know the American Thoracic Society (ATS)?” Lanier asked.
“Yes,” Holcomb said.
“They’re the people who do (treat) pleural effusion, the lung people,” Lanier said.
Lanier produced a communique from the ATS dated November of 2001 that stated, “Talc should not be used for pleurodesis (lung fluid) in patients with nonmalignant pleural effusions.”
“Did you know about this?” Lanier asked.
“No, could you tell me why they said this?” Holcomb asked.
“Sure, it increased the risk of malignant mesothelioma in those patients treated with talc,” Lanier said. “That’s the opposite of what you told us, isn’t it?”
“This is one letter to the editor from one person,” Holcomb said. “Do you have any data?”
“It’s not one letter to the editor from one person,” Lanier countered.
Lanier said the communique had behind it some of the foremost mesothelioma and asbestos researchers in the world. He produced a second portion from a document that read, “An association between carcinogenesis (initiation of cancer) and exposure to asbestos included in talc appears credible.”
Lanier, who estimated that 200 million babies had been powdered with Johnson & Johnson baby powder, said Holcomb was selectively relying on studies showing no increased risk of cancer from talc use, and ignoring those that did show risk.
“Isn’t that true?” he said.
“No, not at all,” Holcomb said.
Lanier named several studies performed in the years 1982 through 2016 he said had found an increased risk of cancer from talc use.