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Krystal Kim vividly recalls the first time she used Johnson & Johnson’s baby powder.

“I was 10 years old. I had just started playing baseball,” Kim, 53, a retired IT professional from Philadelphia, told Healthline. “I used it four to five times a day.”

Kim, a divorced mother of two grown children who still works part-time as a customer service agent for a major airline, said her parents also used it on her when she was an infant.

The family loved the product, she said. But she has a profoundly different view now.

Kim is one of the 22 women with ovarian cancer who filed a multiple plaintiff mass tort lawsuit against Johnson & Johnson (J&J) in judicial circuit court in St. Louis.

The women accused the company with failing to warn them about the cancer risks associated with its popular body and baby powders.

Last week, a jury awarded the women $550 million in compensatory damages and more than $4 billion in punitive damages.

When the verdict was read, most of the surviving women — six have died — were in the courtroom. One of them couldn’t make it because she’s undergoing chemotherapy.

In an interview with Healthline, Mark Lanier, the plaintiffs’ attorney, said, “The trial was difficult for the plaintiffs, and very emotional, but also liberating.”

“They loved being able to take a stand for what they know is right,” he said.

Lanier said each plaintiff got to fight for something greater than themselves.

“They were fighting for untold numbers that have gone before and that will be inflicted this year and years to come,” he said.

With this court decision, Lanier, who’s also a pastor and teacher, said, “The clients have taken a huge step toward their goal of holding J&J accountable and hopefully getting them to take the talc product off the shelf and use its safer alternative, which is corn starch.”

Company stands by its product

Johnson & Johnson, the world’s largest maker of healthcare products, faces more than 9,000 cases involving alleged harm done by its talc-based powder.

But the products remain on the shelf.

And the company continues to insist its talc-based products are safe and don’t cause cancer.

In a statement last week, the company said it “remains confident that its products do not contain asbestos and do not cause ovarian cancer and intends to pursue all available appellate remedies.”

Alex Gorsky, chief executive officer of Johnson & Johnson, said Tuesday that the baby powder doesn’t contain asbestos and that every jury verdict from the St. Louis courts that the company has appealed has been overturned.

During a second-quarter earnings call on Tuesday, Gorsky reportedly said he will fight the St. Louis court decision.

“As you know, our baby powder is a trusted product that we have sold to families for over 100 years and Johnson & Johnson is deeply disappointed in this verdict,” he said during the earnings call.

“We remain confident that our products do not contain asbestos and do not cause ovarian cancer. We intend to pursue all available appellate remedies.”

J&J’s ubiquitous powder

Johnson & Johnson is a multinational company whose total second-quarter sales this year were more than $20 billion, according to a report in Reuters.

The company is known for products such as Tylenol, Acuvue contact lenses, and Band-Aid bandages.

J&J also has a pharmaceutical drug wing that researches and manufactures monoclonal antibodies, immunotherapies, and other types of treatments for cancer and other diseases.

While J&J’s talc-based powder has been a mainstay in the United States for more than a century, in recent years it’s been the center of multiple lawsuits.

Other juries have also ruled in favor of the plaintiffs, but several lawsuits — including court cases in South Dakota and California — have been overturned on appeal.

When asked why judges are overturning jury decisions, Lanier said it’s in part because those cases weren’t focused on asbestos.

“No judge or jury had heard this asbestos evidence before,” Lanier said. “In fact, J&J had made affirmative representations before that there had never been any finding of asbestos in their products and this is blatantly false.”

Representatives of J&J say they expect this case to be overturned.

And they insist that concerns about the talc’s link to cancer are based on inconclusive research.

“This is an outright falsehood,” Lanier said. “Their own internal documents admit that asbestos is present.”

Lanier said J&J tries to deflect the criticism by saying that the measurements of the asbestos don’t always meet the measurements of various geologic tests.

“But that is a semantic game,” he said. “It is tremolite, actinolite, and anthophyllite asbestos found over and over.”

Lanier said that any time J&J challenges him on this, “I simply ask them to remove the confidentiality from their documents so I can show them. The jury saw them and was indignant over the denials.”

Is J&J covering up?

Among the most compelling pieces of evidence for Lanier’s team presented in court were several J&J internal documents that Lanier said showed the asbestos testing procedure the company was using was intentionally sub-par.

“They rigged the tests,” Lanier said. “Internal documents showed that they knew asbestos was present. Together with that, the most rigorous studies used by the most prestigious cancer institutes all indicated there was no safe level of exposure to asbestos and that it was a clear cause and accelerant for ovarian cancer.”

Lanier told Healthline that J&J has been aware since 1973 that if the talc was concentrated before testing for asbestos, the asbestos more readily shows up.

Lanier said the Colorado School of Mines told J&J that pre-concentrating the powder was essential to doing the test correctly and finding any asbestos.

“J&J not only refused to do this test, but pushed an alternate, less sensitive testing procedure on the authorities,” Lanier said. “This concentration approach was deemed ‘not in J&J’s worldwide interests.’”

Furthermore, Lanier said, “J&J played a name game with asbestos, so every time it did show up in testing — and well over 100 tests showed it — they would call it something else.”

J&J said in a press statement that “the multiple errors present in this trial were worse than those in the prior trials which have been reversed.”

But Lanier responded, “This is PR spin to protect the jobs of the people who said they couldn’t lose these cases. This judge is full-on right in his rulings.”

Analyzing the studies

An extensive analysis of multiple studies done by the Cancer Prevention Research journal concluded that exposure to genital powder is associated with “small-to-moderate increases in risk of most histologic subtypes of epithelial ovarian cancer.”

The journal summarized in a paper published in 2013 by the National Institutes of Health that its large analysis of case-controlled studies “shows a small-to-moderate (20 to 30 percent) increased risk of ovarian cancer with genital-powder use, most clearly pertaining to non-mucinous epithelial ovarian tumors.”

The journal went on to note that “more work is needed to understand how genital powders may exert a carcinogenic effect, and which constituents (e.g. talc) may be involved. Since there are few modifiable risk factors for ovarian cancer, avoidance of genital powders may be a possible strategy to reduce ovarian cancer incidence.”

The American Cancer Society notes on its website that for any individual woman, “If there is an increased risk [of ovarian cancer], the overall increase is likely to be very small. Still, talc is widely used in many products, so it is important to determine if the increased risk is real. Research in this area continues.”

Consumer reaction to lawsuit

Meanwhile, consumers are left wondering what to do and who to believe.

Joy Stephenson-Laws is an author and founding partner of Stephenson Acquisto & Colman, a healthcare law firm, as well as founder of Proactive Health Labs, a national health nonprofit.

She said that from a consumer’s perspective these verdicts will go a long way to deter similar future conduct by manufacturers of consumer products.

“However, they do not solve the dire issues these plaintiffs had to deal with,” she said. “So, it is really important that as consumers we take a more proactive approach when we purchase products. We cannot assume we will get a warning if a product is unsafe for our use.”

For example, she said consumers need to learn about the ingredients identified on the labels and not assume they’re safe.

“This includes cosmetic items, as well as cleaning and other products used in the home,” Stephenson-Laws told Healthline. “If we are not sure about how a particular ingredient may affect our health, we should seek advice from our doctors or a competent healthcare professional.”

Stephenson-Laws also recommends that consumers get an annual toxin test to identify unhealthy levels of toxins such as benzoic acid, arsenic, cadmium, lead, or mercury in their body.

“These toxins may come from various foods, consumer products, household supplies, etc.,” she said.

“Once we identify unhealthy toxin levels, we can work with a competent professional to reduce those levels before they create health problems. These health problems include various types of cancers and there is some evidence linking many of these toxins to breast, lungs, and other forms of cancer.”

Rachel Lanier, an associate attorney at the Lanier firm and member of the talc trial team, told Healthline that based on a thorough review of the scientific and medical literature, including dozens of studies going back to at least 1960, the International Agency for Research on Cancer (IARC) has concluded that asbestos causes ovarian cancer.

“The FDA has said that it would be unacceptable for asbestos to be in talc because asbestos is a known carcinogen, but the FDA has to rely on companies, including J&J, to self-regulate and provide them with data and information,” she said.

In 2016, she continued, “J&J told the FDA there has never been asbestos in J&J talcum powder and there never will be. This is simply false and the jury in this case saw dozens of documents that proved it. J&J’s own hired expert, Dr. Matthew Sanchez, testified in this case under oath that he had found asbestos in J&J talc.”

What are the alternatives?

So, what can you do if you don’t feel comfortable using a talc-based powder on yourself or your baby?

Healthline has provided a list of suggestions on its website.

For starters, there are alternatives to talc-based powders.

Among them are those made with corn starch, arrowroot starch, tapioca starch, oat flour, and baking soda.

If you do use talc-based powder, here some recommendations:

  • Don’t put the powder directly on the genitals. Instead, put it on skin around the genitals.
  • Keep baby powder away from your or your baby’s face to avoid inhaling the substance.
  • Shake baby powder onto your hands before applying.
  • Shake baby powder onto a cloth first before putting it on a baby.

Getting on with life

Meantime, Krystal Kim and her co-plaintiffs in this high-profile lawsuit try to get on with their lives.

Kim’s cancer is in remission, but her resentment is still there.

When she first learned about the alleged link between the powder and ovarian cancer, Kim became upset.

“I was caring for my friend’s one-year-old daughter and reached for the powder when I went to change her,” she said.

“I thought about it and threw the bottle across the room. I couldn’t do it to her. I don’t want any little girls to have to go through what I went through.”