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The Expert: Dr. Juan Felix, an expert on cervical cancer testifies for the defense, concluding that he found no link between talc (and the asbestos it allegedly contained) and the woman’s ovarian cancer.
Offering testimony in the 2021 Georgia trial against a pharmaceutical giant, Monroe v. Johnson & Johnson, pathology professor and cytopathology expert from the Medical College of Wisconsin, Dr. Juan Felix, speaks with clear, authoritative tones and logic concerning his findings when investigating whether a deceased elementary school teacher was stricken with ovarian cancer as a result of long term use of baby powder thought to contain asbestos. He spoke as a defense witness.
Felix begins by explaining how the body reacts strongly on a cellular level to any foreign matter. If it is large enough, this material causes a recognized foreign body reaction, and if it is small enough, the material gets “gobbled up” by macrophage cells which clear our bodies of smaller foreign materials and bring them to the lymph nodes. He says that in examining samples from the organs removed in the operative procedures performed on the teacher, he found neither of these processes to be present. The implication is that there was no amount of foreign material present in these samples.
To support his opinion, he demonstrates to the jury with slides, how the patient’s body reacted to suture material that was left in her omentum, a fatty organ within the abdomen. Pointing to cells with many nuclei surrounding a shining material which is a piece of suture. “This is what the body does with foreign material. There is no way that there is a particle inside of a person, where it doesn’t make this reaction.” This is even true when the particle is so small that it cannot be immediately seen on a slide. “That is why I can tell you confidently and with great assurance that there were no foreign particles in Ms. Evans other than this suture.” The presence of this reaction is often seen even when the foreign particle cannot be immediately be seen. The reaction is a clue that tells the pathologist to look at that microscopic field under higher magnification to find the cause. Other than the reaction surrounding the suture material, no other foreign body reactions were noted in this case. This advocates against the presence of talc or asbestos within this patient’s abdomen.
The expert states plainly that the use of the talcum powder played no role in the development of this patient’s cancer. Under further questioning regarding the etiology of this woman’s cancer, he embarks on an explanation of cellular reproduction which is constant from the time we are conceived, giving many opportunities for genetic errors to occur over a lifetime. As cells divide, all of the information in the DNA is expected to be duplicated exactly. With so many duplications occurring, mistakes called mutations invariably will arise. The body has “mismatch repair proteins” that examine the duplications for mistakes and repair them. This process is not always perfect. If the mutation is bad enough, the cell affected will die. Another possible outcome is that the cell is turned into a precancerous cell by the mutation, and it will reproduce the defective cell continually until the whole body dies. Most body cancers can be explained by this natural process, after all, the body is not designed to live forever.
There are well known genetic mistakes that put people at very high risk for the development of ovarian cancer. These would include BRCA1, BRCA2 and BRIT1, all of which are genes which give a high risk for ovarian cancer, but there are likely many more that we are not yet aware of.
The doctor’s testimony was key in putting enough doubt into the minds of the jurors about the cause of the 77-year old’s ovarian cancer. They ruled for the defense.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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