SAN DIEGO – A marketing expert serving as a witness for state attorneys on Monday said Johnson & Johnson had downplayed the risks of its pelvic mesh implants to sell the devices to women in a trial to decide if the company put profits before safety.
“The take-away was that Johnson & Johnson (mesh implants) are quick, safe, minimally invasive, an effective cure,” said Dr. Anthony Pratkanis, a professor of psychiatry at the University of California Santa Cruz. “The risks are downplayed or not mentioned at all. A reasonable consumer would be misled.”
The trial in the San Diego Superior Court is being streamed live courtesy of Courtroom View Network.
The state of California, through its Attorney General Xavier Becerra, sued Johnson & Johnson over a pelvic mesh device called Prolift, made by its subsidiary Ethicon, for allegedly causing vaginal injuries in women and allegedly for selling the product through the use of deceptive marketing practices. Prolift is a clear polypropylene mesh with eight thin connecting arms.
Since 2012, numerous lawsuits have been filed by individual women who had mesh devices implanted and later alleged they suffered intense pain and side effects that required the devices to be surgically removed with great difficulty.
Washington State sued Johnson & Johnson earlier this year in a similar type case, but the company agreed to pay $9.9 million to settle with no admission of wrongdoing. The case in San Diego is the first at trial by a state attorney general over the implant devices and seeks damages under unfair competition and false advertising laws.
The company reportedly sold 42,000 Ethicon pelvic mesh devices between 2008 and 2014, designed to help a sagging bladder condition called pelvic organ prolapse, or POP.
Pratkanis is a specialist in the study of marketing influence and how it impacts consumer behavior. He said he billed $350 per hour for pre-trial work and $400 per hour to testify, a total of about $45,000 so far billed to the state.
Pratkanis said he was assigned to answer the question of what consumers take away from marketing communications made by Johnson & Johnson in presenting the benefits of the sling devices versus the risks, and to what extent such marketing drives consumer demand. He said the company's advertising sent a message that its mesh was superior to other (non-mesh) options.
“Johnson & Johnson tried to create demand by raising awareness and prompting patients to seek treatments from doctors using the J&J mesh,” Pratkanis said.
State attorneys exhibited a number of Johnson & Johnson company promotional materials. One recommended to consumers, “a minimally invasive surgical procedure (mesh) may be right for you.”
Pratkanis said the sales technique in such materials involved repeating over and again the same ideas (minimizing risk) through key words, and varying the words so the reader would not get bored by the repetition.
Company websites stated, “stop coping and start living” and a brochure featuring a character named Bonnie said, “find out how to stop urine leakage like Bonnie did.”
Pratkanis said buzz words are used such as, lightweight, 30-minute minimal invasive, effective treatment, immediate results, effective outpatient treatment, clinically proven, and safe and effective.
“Did you see these buzz words throughout (sales materials)?” Pratkanis was asked.
“Yes,” he said. “They are used to reinforce patient acceptance.”
An exhibited chart described J&J (sales) tactics as consisting of buzz words, social consensus, use of authority figures and imagery.
A statement in promotional materials saying that over 1 million women were treated (for prolapse) and 90 percent of women would recommend it (a sling) to a friend Pratkanis called an example of "social consensus."
“If everybody’s doing it, it must be right,” he said.
The products were also touted to be scientific and clinically proven.
Pratkanis was asked if there was anything wrong with this.
“Not if it’s fair and true,” he said.
Another exhibited document portrayed a mother hugging a young boy with white furniture in the background. Pratkanis called this a “slice of life” technique.
“Women over 40 can identify with that target,” Pratkanis said. “She is able to pick up a young boy (without leaking urine) and the white couch signifies that (urine) leakage could be a problem that you would compensate by having dark furniture.”
Pratkanis said warnings on the product descriptions minimized risks by talking about the surgical procedure rather than risks from the mesh itself.
“None of the warnings here is specific to the mesh,” he said.
"Did it (warnings) say that removal (of mesh) might be impossible or involve multiple surgeries?" he was asked.
"No," Pratkanis said.
"That there was a risk of chronic pain?"