The Saga of Talc and Ovarian Cancer: A case for malpractice reform by Dr Matthew Boente

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By Matthew Boente MD
Gynecologic Oncology
San Francisco

The medical-legal annals are filled with cases of asbestos and talc and their relationship with mesothelioma and ovarian cancer respectfully. In this election season, there has been much written about healthcare’s rising cost. There is rarely a mention of malpractice reform (MF) as a strategy to help lower the cost. Dr Matthew Boente has seen that to date 16,800 plaintiffs have filed complaints against Johnson & Johnson the manufacturer of the baby powder (containing talc) implicated in causing ovarian cancer. Many lawsuits have already been settled, some for billions of dollars. For example, the September 17, 2018 settlement where a St. Louis jury awarded 4.69 billion dollars to 22 women with ovarian cancer where talc was implicated. Additional settlements of 72M and 55M have been awarded to individuals with ovarian cancer and a history of talc use.

Ovarian cancer starts on the surface of the ovary quite different from mesothelioma, which begins in the lung.  There is clear and overwhelming scientific evidence that ovarian cancer’s roots are multifactorial and are related to reproductive factors and genetics, not talc. Ironically, there is no good data to good suggest that talc causes ovarian cancer. Most of the data is old and comes from outdated research models until now. A recent article in the Journal of the American Medical Association (JAMA) reported on over 250,000 women, followed for up to twenty years concerning the use of talc. Conclusions showed that talc use was not associated with an increased risk of developing ovarian cancer. This study (JAMA, 2020;323:49-59) is the most compelling yet that talc does not cause ovarian cancer. It should be considered strongly in the upcoming courts of appeal.

Matt Boente believes the fact that our legal system allows these large awards, without solid scientific evidence, is a travesty. Nobody in the courtroom is an expert on ovarian cancer, except for the expert- witnesses; maybe. Experts give their opinions which are shaped by the attorneys. The jury is left with a decision to believe one or the other. How can lay jurors comprehend these extremely complicated scientific issues like carcinogenesis? Juror’s decisions are groomed by attorneys who know only slightly more than the plaintiffs about ovarian cancer.  How many gynecologic oncologists or molecular biologists were on those juries?  Why are so many cases being brought to St. Louis, MO area courts?  Interestingly, the law currently allows a judge to decide if a jury or the judge can or can’t decide on a settlement amount.

Ovarian cancer is a devastating disease, which proves lethal to most of the people who acquire it. I’ve spent a lifetime researching and caring for these patients. They are complicated. Carcinogenesis is too complicated for lay juries to understand. It’s easy for a jury to make an emotional decision and point the finger so that someone compensates the sick.

News of these large settlements makes doctors anxious. Research in this arena confirms that physicians order numerous unnecessary tests to rule out rare diagnoses in order to avoid lawsuits. The ordering of unnecessary tests happens many times per day in every hospital in the US. It’s so commonplace that physicians don’t recognize that their behavior is financially irresponsible. So, doctors drive up costs by ordering tests to CYA. Anyone else see the absurdity of this?

MF falls under the umbrella of the healthcare reform. The responsibility for MF should be shared by attorneys, physicians, insurance executives, and lawmakers. There are so many costs, directly and indirectly, related to medical malpractice that most people don’t realize the enormity of its financial impact. Imagine if there was a way to make these awards smaller by, “capping” the amount of the rewards. Insurance companies will save money, insurance premiums for physicians will drop, but we must ensure these savings are passed to patients in the form of lower premiums.

President Trump to date has not had much success in solving this or any of the big healthcare issues since he was elected (ie.coronavirus, the opioid crisis, gun law reform/mass shootings). Negotiations in these areas are difficult because they require legislators to negotiate with the trial lawyers lobby who contribute to their campaigns. Joe Biden is the only candidate whose past history and co-authorship of Obamacare shows his dedication to making healthcare better for patients. MF will go a long way to improve conditions on the ground with doctors and nurses and will help lower the overall cost of healthcare.

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