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# Jury awards $4.7bn damages against Johnson & Johnson in talcum cancer case BMJ 2018; 362 (Published 16 July 2018) Cite this as: BMJ 2018;362:k3135 1. Owen Dyer 1. Montreal A jury in St Louis, Missouri, has ordered Johnson and Johnson to pay$550m (£415m; €471m) in compensatory damages and $4.14bn in punitive damages to women who alleged that use of the company’s talcum powder caused them to develop ovarian cancer. The lawsuit was brought by 22 women from across the US, six of whom have since died. More than 9000 former US talcum customers have lodged suits against the company. Most claim damages for ovarian cancer, but some allege that using the product led them to develop mesothelioma. The award is by far the biggest yet against Johnson and Johnson in litigation relating to talcum powder and the first case in which plaintiffs alleged that asbestos in talcum powder caused their disease. “We hope this verdict will get the attention of the J&J board and that it will lead them to better inform the medical community and the public about the connection between asbestos, talc, and ovarian cancer,” said Mark Lanier, the lawyer representing the 22 women. “The company should pull talc from the market before causing further anguish, harm, and death from a terrible disease.” While the product’s prime ingredient, mineral talcum, is normally found alongside asbestos in nature, the company has long maintained that careful choice of mining sites and thorough processing has kept its baby powder and other talcum products free of asbestos since the 1970s. Tests by the FDA have supported the company’s contention, but expert witnesses in the Missouri trial told the jury that they had found talcum particles and asbestos fibres in the women’s ovarian tissue. Four other talcum suits in St Louis, which made no claims about asbestos, have ended in jury awards against Johnson and Johnson of$55m, $70m,$72m, and $110m, but two have since been overturned. A jury in California last year ordered the company to pay$417m, but that verdict was quashed on appeal. Johnson and Johnson has also won cases in Missouri and New York.

The company said that the latest verdict was the result of a “fundamentally unfair process,” because women from all over the US were being brought before juries in St Louis, a jurisdiction popular with lawyers taking on large corporations.

“The evidence in the case was simply overwhelmed by the prejudice of this type of proceeding,” the company said in a statement. “Johnson and Johnson remains confident that its products do not contain asbestos and do not cause ovarian cancer. Every verdict against Johnson and Johnson in this court that has gone through the appeals process has been reversed and the multiple errors present in this trial were worse than those in the prior trials.”

In the most recent appeal brought by the company, a higher Missouri court ruled that a woman from outside the state had lacked standing to bring a case there. If the latest verdict does stand, the damages awarded are likely to be drastically reduced by a judge on review.

In a statement, Johnson and Johnson pointed to research from the Nurses’ Health Study, the Women’s Health Initiative observational cohort,1 and the Sister Study (2003-9), which it said “found no association overall between talc use and ovarian cancer.”

However, a simplification of the Nurses’ Health Study did find an association between talc use and the most aggressive, invasive ovarian tumours. Follow-up research on that cohort extended those findings while suggesting that risk was linked to particular gene mutations.2 Other researchers studying that cohort found an association between talc and risk of endometrial cancer.3

The American Cancer Association and the UK ovarian cancer charity Ovacome both call the evidence for a link between talcum and ovarian cancer inconclusive. The WHO’s International Agency for Research on Cancer lists talcum as a class 2B chemical that is “possibly carcinogenic,” citing the Nurses’ Health Study.

The Sister Study found no association between cancer and talcum use but noted that users were more likely to practise vaginal douching, which was quite strongly associated with ovarian cancer risk.4

Three suits against Johnson and Johnson over talcum and mesothelioma have concluded in the past three months, one with a mistrial and the other two with jury awards against the company of $11m and$25.75m.

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