
Johnson and Johnson Has a Baby Powder Problem - guiseroom
http://www.bloomberg.com/features/2016-baby-powder-cancer-lawsuits/
======
mschuster91
> She lost her health insurance because she exceeded the policy limits and had
> to skip her last chemo treatment.

What in fucking hell is this? An insurance exists to _protect_ people from
going bankrupt due to health issues, not to screw people over when they're
already in no position to fight.

How on earth is this legal?

~~~
ams6110
It is legal because there was a limit defined in the policy.

No insurance is open-ended, sky-is-the-limit. In many cases (e.g. auto, home,
business) the limit is capped at the value of the assets that are insured. In
other cases (liability) there is a defined dollar limit. My homeowners and
auto policies have liability insurance but there is a limit. If I caused a
traffic accident with signifcant property damage and multiple serious
injuries, my liability insurance limit would likely be exceeded.

Health insurance has limits as well, even with the recent changes that the ACA
introduced. The ACA removes limits on "essential health benefits" but who
decides what those are? Hint: Not you.

If there were no limits on health insurance there would be little backpressure
to ensure that care provided is worth paying for, or to put it another way,
has real benefit. You'd have hopeless cases on life support forever, or
unrealistically expensive treatment of conditions for which there is no real
hope.

Sad as it is, some health problems can't be fixed, and at some point you need
to admit that and stop throwing money away. One more chemo treatment would
very likely have made little difference in the outcome for this woman.

~~~
rsync
"If there were no limits on health insurance there would be little
backpressure to ..."

Also, it wouldn't be insurance.

People think that insurance is "something that I want that does nice things
for me". It's not.

Insurance is a math problem and it has a precise answer. If you go beyond that
answer _it doesn 't work_. Either you're getting screwed or the (hapless)
insurance company _goes out of business_.

~~~
jfoutz
The math problem is tricky in a lot of ways though. For example, the rate the
insurance company pays doctors is different than the retail rate. Lots of
people don't realize this. It also brings up two pretty interesting questions.
One, could the patient have covered the last session at the price insurance
companies pay? And two, does the insurance company run down that upper limit
based on the amount they're billed, or the amount they pay?

There's another interesting policy question. Insurance, flat out, can't pay
for everything. So, given that they have a pool of money, do you allocate that
toward the least sick people? That's probably a better approach to more total
years of survival. ensure the healthiest 50% (or whatever) get excellent care,
and let the rest go. Alternatively, do you triage and spend the the money on
people who have a slim chance of survival, making the heroic rescue day after
day?

I find that policy decision horrifying. I honestly have no idea how they pick.
But it's pretty obvious, somebody getting chemo means 100 other people aren't
getting, for example, cholesterol medication.

I'll agree it's just an equation. but man, i'd love to see those tables
showing years of human life saved based on condition and treatment. Just to
add a touch more cynicism, should those years be weighted based on economic
productivity? Would we be better off with 10 more years of Steve Jobs or 10
more years of Grandma? My gut says Grandma, but... it's just an equation.

~~~
golergka
They don't have a "pool" of money; they have exact obligations to each of
their clients.

~~~
jfoutz
huh. that's weird. it _seems_ like all the customers throw in their money
every month. some percentage of that must go to overhead and profits, the rest
would go into a pool for medical care. Each month the insurance company would
pay whatever is required for specific obligations, with any extra carried over
to the next month. From time to time there would be random fluctuations,
unusually high numbers of heart attacks for example, and they'd run at a loss.
I thought insurance companies work just like casinos with harder to estimate
probabilities of having to pay out. The thing that's _really_ cool about being
an insurance company, you don't have perfectly clear obligations. With a
casino, they land on double zero at roulette, the casino has to pay. With
insurance, the insurance company gets to decide the worthiness of paying out.
Oh yes, this person has cancer, but the chance of survival is quite low, so
we're not paying for chemo.

But, clearly, i'm mistaken. Could you elaborate on how the insurance business
really works?

~~~
golergka
> With insurance, the insurance company gets to decide the worthiness of
> paying out. Oh yes, this person has cancer, but the chance of survival is
> quite low, so we're not paying for chemo.

I don't know about US, but it seems like normal people would have laws and
regulations to govern that kind of decisions.

~~~
criddell
In theory, you do. Lots of companies sell insurance and you can buy the
coverage you want. In a single payer system, you are stuck with what the
government gives you and that is where the "death panel" talk comes from.

------
ars
I've known for at least a decade that talc was dangerous.

I was 100% under the impression it was taken off the market years ago and
replaced with corn starch.

Reading this article is the first time I realized it was not taken off the
market, and I'm very confused.

How can I know this is dangerous and the company that makes it not know? I
thought it was common knowledge.

I'm having a hard time expressing how perplexed and confused I am to hear talc
is still on the market.

I mean, it says "not to inhale it" \- how can you possibly apply it and not
inhale some of it? It's impossible. There is no way to use this safely without
a gas mask.

~~~
raverbashing
Do you know what else can be deadly when inhaling it? Water

Limit is 2mg/m3 for 8h days
[https://en.wikipedia.org/wiki/Talc#Industrial_grade](https://en.wikipedia.org/wiki/Talc#Industrial_grade)

~~~
ars
And?

It's possible to use water safely, it's not possible to use talc safely
without PPE.

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grizzles
I've known about this molecular similarity to asbestos for 15 years, and have
pretty much warned every barber or hairdresser that I've ever been to. They've
never listened. I moved to a different city but I heard about a year ago the
hairdresser at a place I used to frequent has lung cancer. Was it the cause?
Who knows, but it sure is sad to hear. Regular people are just horrible about
assessing / understanding risk. Baby Power is like the climate change of the
local hairdressing world. That might be a slight overstatement, but gosh they
sure use a ton of it here.

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donatj
Anything that hasn't been shown to cause cancer yet simply hasn't been
investigated hard enough.

~~~
golergka
Dihydrogen monoxide.

~~~
grecy
...talk to the people in Flint

~~~
golergka
You know the difference between H2O (distilled water) and water, right? Like,
which one of those is conductive and which one isn't, all that stuff?

------
reirob
Quote:

> “People were using something they thought was perfectly safe,” he says. “And
> it isn’t. At least give people the choice. J&J didn’t give people a choice.”
> Among the most painful revelations, he says, was that in the 1990s, even as
> the company acknowledged concerns in the health community, it considered
> increasing its marketing efforts to black and Hispanic women, who were
> already buying the product in high numbers.

Cynical question: Was increasing marketing efforts to black and Hispanic women
out of racism or a cold risk calculation in the hope that these women couldn't
afford to defend themselves as good as other groups? Will J&J be persecuted
for this discrimination?

Disclaimer: I am not from US, but by reading HN I am often surprised how
things work in US.

~~~
golergka
> Cynical question: Was increasing marketing efforts to black and Hispanic
> women out of racism or a cold risk calculation in the hope that these women
> couldn't afford to defend themselves as good as other groups? Will J&J be
> persecuted for this discrimination?

Corporations of that size aren't usually coordinated that well, in my
experience. Most likely, they were just putting marketing money in the
demographics they identified in some surveys, and marketing manager
responsible for that decision was from completely different department from PR
guys handling the health issue.

~~~
alphonsegaston
I don't know if this is true for J&J, but the paint industry is quite large
and banked on racism allowing them to get away with harmful lead additives.
This kind of cold calculus is hardly out of bounds for US corporations:

The lead industry even sought to place the blame for lead poisoning epidemic
on parents and children, claiming that the problem was not with the lead paint
but with the "uneducable Negro and Puerto Rican" parents who "failed" to stop
children from placing their fingers and toys in their mouths. Children
poisoned by lead, the industry claimed, had a disease that led them to suck on
"unnatural objects" and thereby get poisoned.

[http://www.theatlantic.com/health/archive/2013/04/why-it-
too...](http://www.theatlantic.com/health/archive/2013/04/why-it-took-decades-
of-blaming-parents-before-we-banned-lead-paint/275169/)

------
s_q_b
It does not surprise me that introduction of small particulates to any orifice
on a daily basis would increase cancer risk. Household dust increases cancer
risk.

The cover up orchestrated by Johnson&Johnson here, however, is the deplorable
story.

~~~
djrogers
FTR, this issue has nothing to do with inhalation - it's about its use in
women's undergarments, and the link between that an ovarian cancer.

~~~
kzhahou
I'm just a simple man, but I don't understand how a fine-grained powder, even
entering the vagina, could cause ovarian cancer. This very long article spends
only two paragraphs asking that question, with no answer.

Sounds like pesudo-statistical lawyering. This woman has cancer and she used
talc every day of her life, ergo the talc is to blame.

~~~
mirimir
One might ask why asbestos causes mesothelioma. Maybe the mechanisms are
similar. Although talc is obviously less effective. But if there's increased
risk, the lack of mechanistic understanding doesn't negate the evidence.

~~~
refurb
We already know why asbestos causes mesothelioma. Asbestos can form very small
particles that go deep into the lung (there is good relationship between
particle size and how deep it penetrates into the lung). Asbestos contains
iron and the iron can promote free-radical formation, thus DNA damage and thus
cancer. Yes, I'm simplifying it, but that's what I remember from my toxicology
classes long ago.

I don't think it's odd to question the toxicity of talcum powder. Talcum
powder used to contain asbestos, but doesn't any longer. We have good evidence
that the newer talc doesn't cause lung cancer.

So an obvious question is, if talc doesn't cause lung cancer, why would it
cause ovarian cancer? Of course, different tissue, different effect, but it
raises doubt.

Maybe talc does cause ovarian cancer by some as-yet-discovered mechanism, but
I wouldn't blame anyone for thinking it either coincidental (lots of people
get ovarian cancer who never use talc) or due to something else.

~~~
danieltillett
I was under the impression that the cause was chronic inflammation resulting
from recruitment and activation of macrophages and other immune cells to site
of the fibres [1]. Chronic inflammation causes cancer on its own independent
of external factors like free radical formation.

1\.
[https://en.wikipedia.org/wiki/Mesothelioma](https://en.wikipedia.org/wiki/Mesothelioma)

~~~
refurb
Well, I should have added details. You are correct that asbestos that doesn't
contain iron can still cause cancer through a hypothesized inflammatory
mechanism.

Honestly, I don't we know the exact mechanism, but have some theories that
seem to fit.

~~~
mirimir
And that, perhaps cryptically, was my point. Why should any chemically inert
mineral cause cancer? But some apparently do, regardless. Inflammation seems
most plausible.

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aaron695
Although you'd have to be a total idiot to give much attention to such a
idiotic, emotive article there does seem to be evidence inhaling mico
particles is very very bad.

Be it cigarette smoke or a fireplace or smog or perhaps talcum power use =
mico particle inhalation.

If there's a real story here this is where it might be, or give me a better
written article that is about scientists not juries.

~~~
lostlogin
What is in your underwear that allows micro inhalation? The association
doesn't appear to be linked to inhalation in any way.

