There is nothing unethical about a business house making profit. It is their dharma. But their products should always be beneficial to end users and certainly not cause them harm. It is important to follow the principles of beneficence and nonmaleficence, particularly in the pharmaceutical and allied industries manufacturing healthcare products. Full disclosure of potential health or environmental risks is essential. Unfortunately, several companies have not come out with full disclosure, and have thus been found lacking in accountability.
One such instance is the resumption of manufacture and sale of baby talcum powder by the giant multinational, Johnson and Johnson(J&J). In the first week of March 2019, advertisements appearing in some Indian newspapers claimed their baby talcum powder was “safe, pure and gentle and asbestos free” (1). Prior to this, in December 2018, the Central Drugs Standard Control Organisation, the national regulatory body for pharmaceuticals and medical devices, had ordered the company to stop manufacturing baby powder till it was proven asbestos-free (2) . The newspaper advertisements in March 2019 came immediately following a clean chit from a government laboratory in Chandigarh, stating that tests of samples of baby talcum powder provided by J&J, showed that the baby powder was of “standard quality” and free of asbestos (1).
Measurement of asbestos in the air or in any product for human consumption can be extremely challenging. First, even very small doses of the fibrous mineral in the talc can be dangerous over prolonged and sustained use. Second, detecting such small doses can be difficult. Third, both fibre diameter and length are directly related to the toxic effects of asbestos. Therefore, certifying a product “free of asbestos” and “safe” requires rigorous and high-quality testing (3) .
According to a Reuter’s report (4) , J & J has been facing thousands of lawsuits related to asbestos in its talcum powder since 1971, alleging that use of its talcum powder has caused women to develop cancer. J&J has strongly denied the presence of asbestos or any link to cancer, as also the charge of withholding information. Meanwhile, the Hindu Business Line (5) , reported, on March 15, 2019, that a California jury had awarded $29 million to a woman who claimed that asbestos in Johnson & Johnson’s talcum-powder-based products had caused her to develop cancer. The verdict of the California Superior Court in Oakland marks the latest defeat for the healthcare conglomerate facing more than 13,000 talc-related lawsuits nationwide in the US. J&J plan to appeal at a higher court. The World Health Organisation and other authorities recognise no safe level of exposure to asbestos (6) . Even the strictest occupational exposure limits are associated with health risks for asbestos related diseases.
There is also a fear that inhalation of pure talc, often due to abundant daily use is associated with pulmonary talcosis (7) . In the US and several other countries, mothers refrain from dusting babies with baby talcum powder.
Under these circumstances, it is unethical to expose our babies and children to a known risk, however small. Rather than remaining silent, as in the case of ASR Hip implants that were marketed in India by DePuy, a subsidiary of J & J (8) , I call upon the concerned government authorities, particularly, the Ministry of Health and Family Welfare, to revisit the permission given to resume manufacture of talcum baby powder and collect more evidence about its safety. I appeal to all medical and health professionals and all those concerned about health to recognise the hidden threats in such products and take steps to save our children and women.
DK Srinivas (firstname.lastname@example.org), Dean (Retired), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, Dhanvantari Nagar, Puducherry, 605 006 INDIA.