Firstly, I had a great day with the first cohort of SCC last Friday, a small but perfectly formed group, IMHO.
We talked about CORE principles of Chiropractic, the sustained inflammatory response, how to adjust the nerve firing threshold and more, what a pleasure.
Also, if you are in Ireland, please come to our event on Saturday November 14th in Killashee.
- Optimising collagen production for healing, tendonitis, ligament sprains, osteoporosis, cartilage (degenerative change)
- Calming inflammation and pain naturally using the word’s most scientifically tested turmeric, and how to adjust pain firing thresholds with supplements.
- Understanding iron metabolism; non-anaemia iron deficiency and iron overload including haemochromatosis
- Easy solutions to IBS – How IBS links in with fibromyalgia and depression
The Iron webinar was a great evening. Sadly, the recording did not work and despite my best efforts, the technology this morning also failed me, so it will be done next week.
For decades, talcum powder was considered one of the safest products found in the family home.
Associated with babies, cleanliness and gentle skin care, it became a trusted household staple used by millions of people around the world.
Few consumers would ever have imagined that a product marketed for infants could become the subject of one of the largest product liability cases in history.
The controversy surrounding talc serves as a powerful reminder that healthcare professionals should remain both scientifically curious and appropriately sceptical, especially given previous scandels we will discuss later.
It also reinforces an important principle that extends far beyond talcum powder itself:
The responsibility for demonstrating that a product is safe lies with the manufacturer, not with consumers or healthcare practitioners having to prove that it is harmful.
This distinction is fundamental to good science. In science, the absence of evidence of harm is not the same as evidence of absence of harm.
Simply because harm has not yet been conclusively demonstrated does not mean that a product is necessarily safe.
Sometimes the appropriate studies have not yet been performed. Sometimes they have been too small, too short or inadequately designed.
Sometimes the disease being investigated takes decades to develop.
Sometimes analytical techniques simply were not sensitive enough when a product first entered the market.
Scientific knowledge evolves, and conclusions should evolve with it.
The controversy surrounding Johnson & Johnson centred on whether some cosmetic talc products were contaminated with asbestos.
Talc and asbestos are naturally occurring minerals that can occur in close proximity within the earth. If talc is not carefully sourced and purified, contamination is possible.
Cosmetic grade talc is intended to be asbestos free, but historical mining practices and testing methods have been the subject of intense scrutiny.
Over many years, thousands of individuals alleged that prolonged use of talc products contributed to either mesothelioma, a cancer strongly linked to asbestos exposure, or ovarian cancer.
Internal company documents disclosed during litigation attracted widespread public attention and raised questions regarding historical testing, quality control and communication about potential contamination.
Johnson & Johnson has consistently maintained that its talc products were safe and asbestos free while continuing to dispute many of the allegations made against it.
Whatever the outcome of every individual case, the scale of the litigation is extraordinary. Tens of thousands of claims have been filed in the United States and across the world, leading to numerous jury verdicts, appeals and proposed settlements worth many billions of dollars.
Here is but one example of $4.69 BILLION payout.
The company has also discontinued its talc based baby powder in many markets and replaced it with a corn starch formulation. Though they deny any wrongdoing, obviously (nothing says I am innocent like handing over 4.69 billion in one case).
From a scientific perspective, the strongest association concerns mesothelioma. Asbestos is an established human carcinogen, with disease often developing 20 to 50 years after exposure.
Some independent investigators have reported finding asbestos fibres in historical cosmetic talc samples, while others have questioned the consistency or interpretation of those findings. Reconstructing exactly who was exposed, at what level and over what duration decades after the event is exceptionally difficult.
The relationship between talc and ovarian cancer remains more controversial.
Some observational studies have reported a modest increase in risk among women with prolonged genital talc use, whereas other large prospective studies have failed to demonstrate a statistically significant association.
Regulatory agencies continue to review the evidence, acknowledging both biological plausibility and the limitations of the available data.
One reason these questions are so difficult to answer is that proving environmental harm is vastly more complicated than many people appreciate.
Unlike testing a medicine over several months, environmental exposures usually occur at low levels over decades.
During that time individuals are simultaneously exposed to countless other variables including smoking, alcohol, obesity, diet, occupational chemicals, medications, hormone status, infections, air pollution, genetics and socioeconomic factors.
Untangling the contribution of one specific exposure from dozens of other potential influences is one of the greatest challenges in epidemiology.
This complexity does not mean an exposure is harmless. It simply means that proving causation is difficult.
Epidemiologists attempt to isolate one possible contributor from many others that may be acting simultaneously.
As a result, uncertainty is inevitable, particularly early in the scientific process.
Another important concept is cumulative toxic burden.
Human beings are never exposed to a single chemical in isolation.
Throughout life we encounter thousands of substances from food, water, medicines, plastics, pesticides, cosmetics, household products, cleaning agents, air pollution and occupational environments.
Each individual exposure may fall below an accepted safety threshold, but that does not necessarily mean that combinations of exposures over decades are biologically irrelevant.
Modern toxicology increasingly recognises that cumulative exposure and interactions between multiple agents represent one of the major scientific challenges of this century.
The same principle is familiar within nutrition and lifestyle medicine. Poor sleep alone may not cause disease.
Neither may an unhealthy diet, chronic stress, inactivity, obesity or micronutrient deficiencies.
However, when these factors occur together, disease risk increases substantially.
Environmental toxicology is unlikely to be fundamentally different. Numerous relatively small influences may combine over many years to increase disease risk, even though each individual exposure appears relatively insignificant when examined in isolation.
This is why in functional medicine/nutrition we take a systems biology approach.
These challenges help explain why scientific certainty often takes decades to emerge.
Cigarette smoking is perhaps the best example.
Today the links between smoking, cardiovascular disease, lung cancer and numerous other illnesses are beyond reasonable scientific dispute. Yet reaching that conclusion required decades of epidemiological research.
Perhaps even more concerning was the response of parts of the tobacco industry.
Internal documents released through litigation later demonstrated organised efforts to challenge the emerging science, emphasise uncertainty and manufacture doubt.
Rather than attempting to resolve scientific questions, significant resources were devoted to convincing the public that the evidence remained inconclusive.
This delayed regulation and almost certainly contributed to millions of preventable deaths worldwide.
Epidemiologist Devra Davis has documented much of this history in The Secret History of the War on Cancer.
Which, FYI, is one of my favourite books of all time.
Reads like a novel, a scary one.
Click and grab a copy 👇
She describes how occupational and environmental carcinogens were often recognised by scientists many years before effective public health measures were implemented.
Whether or not one agrees with every conclusion she reaches, her central message is difficult to dismiss:
Uncertainty should stimulate better research, greater transparency and more rigorous investigation, not complacency or defensive efforts to create doubt.
History offers other important lessons.
One of the best known is Vioxx, developed by Merck & Co. Marketed as a safer anti-inflammatory medicine, it became one of the world’s bestselling drugs before evidence accumulated that it increased cardiovascular risk in some patients.
The drug was voluntarily withdrawn in 2004 following results from a clinical trial.
Subsequent litigation, scientific publications and internal company documents generated widespread criticism regarding how emerging safety concerns had been interpreted and communicated.
The episode remains one of the clearest modern reminders that robust post-marketing surveillance and independent scrutiny are essential components of patient safety.
Debates surrounding transparency continue today. An example is the work of the Cholesterol Treatment Trialists’ (CTT) Collaboration, led by Sir Rory Collins.
The collaboration has produced many influential analyses supporting statin therapy and has significantly shaped international cardiovascular guidelines.
At the same time, independent researchers have argued that wider access to anonymised patient level trial data would allow independent groups to verify findings, explore unanswered questions and improve scientific transparency.
Put simply, independent data on statins, finds very little, if any, benefit in terms of all-cause mortality (excluding trauma).
Note that since 2004 it has been illegal to tamper with data in a trial, and since 2004 the trials on statins seem to find no/little benefit, even with secondary prevention (aka they all already had one heart attack, meaning the strike rate for saving lives