Confidence Game: Burson-Marsteller's PR Plan for Silicone Breast Implants

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This article was first published as "Confidence Game: Burson-Marsteller's PR Plan for Silicone Breast Implants", PR Watch, Volume 3, number 1, First Quarter 1996. The original article was authored by John Stauber and Sheldon Rampton and is used here with permission. As with all SourceWatch articles, feel free to edit and revise. --

Once reviled as corporate villains, the manufacturers of silicone breast implants have made a stunning comeback recently in the court of public opinion. A series of scientific studies and news stories have emerged, arguing that breast implants are in fact harmless, and that companies such as Dow Corning and Bristol-Myers are hapless victims of misguided women, greedy attorneys and manipulated juries.

This turnaround is no accident. PR Watch has obtained internal documents from Burson-Marsteller, the PR firm which engineered Dow Corning's PR strategy in the early 1990s. These documents provide an intriguing peek into a massive, expensive, and carefully orchestrated campaign that integrates state-of-the-art grassroots PR with subtle manipulations of science and the legal process.

From Cover-up to Blow-up

The PR story begins in 1985, when Burson-Marsteller warned Dow Corning of "the potential for a corporate media crisis" after a federal jury in San Francisco ordered the company to pay $1.7 million to Maria Stern in Carson City, Nevada for what the court judged were "defectively designed and manufactured" breast implants. The jury judged Dow Corning guilty of fraud, based on internal corporate memos and studies showing that the company had failed to inform the public of health risks related to implants.

Although the Stern case received slight media coverage, Burson-Marsteller wrote an analysis titled "Silicone Medical Implants as a Public Issue," in which the PR firm predicted that "the combination of human suffering, large financial awards, big business and big medicine . . . represent a potentially volatile media situation for the company."

After unsuccessful attempts to overturn the Stern verdict, Dow's lawyers negotiated a settlement in which the company agreed to pay the judgment in exchange for a "protective order" blocking public access to embarrassing internal documents and testimony which had emerged during the trial. In a series of subsequent cases filed by other plaintiffs, Dow settled out of court, again obtaining secrecy orders to keep damaging information from reaching the public.

In the late '80s, however, Dr. Sydney Wolfe, the head of Ralph Nader's Public Citizen Health Research Group, became an outspoken critic of implants. Women's groups also began pressuring the FDA to ban silicone implants.

In December 1990, the story hit big on Connie Chung's Face to Face on CBS-TV, which featured interviews with a series of seriously ill women who blamed implants for their conditions. The show touched off a frenzy among women with implants, and the FDA came under additional public pressure. In March 1991, a New York City court awarded $4.5 million to a woman who claimed that implants had caused her cancer.

Juries judged Dow Corning guilty of fraud, based on internal corporate memos documents showing that the company failed to inform the public of health risks related to implants.

As the crisis grew, so did the company's PR campaign. In 1990, Burson-Marsteller billed a paltry $6,000 in PR fees to Dow Corning, but "From May 1991 through February 1992 our billings have been $3,776,000, with gross income of $1,384,000," stated Burson-Marsteller Senior Vice President Johnna Matthews, in a March 10, 1992 letter marked "confidential" to Larry Snodden, President of B-M/Europe.

According to Matthews, Dow's PR crisis exploded when yet another implant recipient, Marianne Hopkins, sued the company and the "jury reached a verdict in December 1991. They found Dow Corning guilty of fraud, oppression and malice with damages of $7.4 million. Damning memos on issues of quality control and safety, which had been under protective orders, reached the public and we've been playing catch-up ever since. . . . Our job has become damage control of language that compares breast implants to the 'Pinto gas tank' and a multitude of other comments" in memos which are "almost impossible to defend in court and certainly in the 'court of public opinion.' "

By 1992, the FDA had imposed a ban on further breast implants, and implant manufacturers faced lawsuits worth billions of dollars. Dow began to fear for its very survival, as breast implants threatened to become a wedge opening the company to even wider scrutiny. "There are other issues on the horizon for them," Matthews wrote. "All silicones may be attacked, their other medical devices like joints are under attack and they have some environmental issues too."

In a separate strategy document, Burson-Marsteller advised, "We must aggressively fight a world in which 'silicone-free' becomes a labeling boast."

Mobilizing the Masses

As the FDA moved toward hearings on the implant controversy, Dow and the plastic surgeons launched a fierce PR counterattack. Burson-Marsteller and its subsidiary, Gold & Liebengood, led the charge for Dow, while the plastic surgeons retained the PR firms of Kent & O'Connor, along with Black, Manafort, Stone & Kelly, another B-M subsidiary.

One of Dow's internal memos from that period has been cited by critics of the company as evidence that the company was engaged in deliberate deception. Plaintiffs and their attorneys have emphasized a sentence from the memo in which Dow CEO Dan Hayes states, "The issue of cover-up is going well from a long-term perspective."

Less attention, however, has been given to the remainder of the Hayes memo, in which he describes clearly the company's PR strategy. "The number one issue in my mind is the establishment of networks," Hayes states. "This is the largest single issue on our platter because it affects not only the next 2--3 years of profitability . . . but also ultimately has a big impact on the long-term ethics and believability issues. . . . I have started to initiate surgeon contact . . . to organize the plastic surgery community. . . . The place we have the biggest hole still missing . . . is in this whole arena of getting the patient grassroots movement going."

"Grassroots" has become a corporate buzzword for a PR strategy which uses corporate wealth to subsidize orchestrated mass campaigns that put seemingly independent citizens on the front lines as activists for corporate causes. Phillip Morris, for example, has paid Burson-Marsteller tens of millions of dollars to organize smokers into the National Smokers' Alliance, which effectively lobbies for the company in the name of "smokers' rights."

Johnna Matthews described B-M's grassroots strategy for Dow in a confidential letter on September 9, 1991 addressed to B-M subsidiary Gold & Liebengood. "I was not going to put this into writing, but wanted you both to be up to speed--and there's too much information for you to have to listen to it all verbally," Matthews wrote. "With the FDA's new penchant for walking into ad agencies and demanding to look at documents, I hope you'll give this a toss once you've read it."

According to Matthews, "No one really knows why the women who have problems have them. . . . It may be that there are women with an allergic reaction to the silicone gel," although she termed this "unlikely."

Worried that the FDA was considering a ban on silicone breast implants, Matthews outlined a strategy for "getting women angry about having the right to make their own decision about implants taken away from them. . . . We also want to place regional, and if possible, national media stories on the need for keeping this option open to women."

Star Search

Another internal document describes Burson-Marsteller's grassroots organizing tactics in more detail: "Utilize a well-known celebrity who has breast implants for reconstructive purposes to speak out on the benefits of them. Utilize spokespeople drawn from women's cancer support groups in major markets to defend implants by writing letters to the editor, participating in media interviews, and communicating positive messages to women's groups in their regions."

Burson-Marsteller turned to the American Society of Plastic and Reconstructive Surgeons for help in identifying patients who could be recruited as spokespeople. After regional spokespersons had been enrolled around the country, "we can announce the celebrity chairperson as head of the national women's cancer support organization (name to be determined). . . . (Dow Corning -ed) makes corporate grant to this organization. . . . Agency to provide day-to-day media support for the group. . . . These women (including celebrities) will be trained and testimony will be written for them to deliver before Congressional committees."

In a preliminary budget, B-M suggested that Dow should be prepared to pay $891,000 to get the grassroots program up and running, including a $300,000 "participation fee" to its celebrity spokesperson.

In practice, it appears that Dow was never able to find an adequate celebrity willing to fill the desired role. Only two celebrities have gone public talking about their experiences with implants--talk show host Jennie Jones and former "Waltons" actress Mary McDonough, both of whom have spoken out against health problems which they believe were caused by their implants.

Seeking Sympathy

B-M's focus groups showed that it could get the most favorable press coverage by highlighting cases of women with breast cancer who have had mastectomies and used implants for the purpose of breast reconstruction. "While these are only 15-25% of implant patients--the rest are augmentation--they engender more sympathy," Matthews wrote.

For similar reasons, Burson-Marsteller advised that cancer specialists should be recruited as "spokesdoctors" to defend the company in the top 15 media markets in the United States, because "an oncologist obviously has more credibility than a plastic surgeon."

As Dow Corning geared up for hearings on implant safety scheduled for November 14, 1991, Burson-Marsteller worked to organize a massive "Washington fly-in." B-M staffer Cindee Castronovo was put in charge of bringing up to 1,000 women to Washington to rally in favor of implants, with Dow Corning footing the bills for their travel and lodging, plus several days of rehearsals and training prior to the actual testimony.

Participants in the fly-in included a writer named Karen Berger and breast cancer support groups Y-ME, the Susan B. Komen Foundation, and the National Alliance of Breast Cancer Organizations (NABCO). Y-ME was given the assignment to generate 175,000 letters to Congress.

Berger, a former schoolteacher, was neither a cancer survivor nor an implant recipient. Her authority as an expert on implants was based on her authorship of A Woman's Decision: Breast Care, Treatment and Reconstruction. Co-authored with plastic surgeon John Bostwick III, the book encourages women to seek reconstructive surgery following mastectomies. Burson-Marsteller pitched her to the press as the author of "survey work" which "shows that the majority of breast cancer patients who have been reconstructed find implants very valuable."

Berger's name appears repeatedly on internal Burson-Marsteller documents, which describe her as a "primary recruiter" for the Washington fly-in. In a USA Today profile, however, Berger is described as an "independent medical publisher" who "says she has no connection with any organization." "The suggestion that women should martyr themselves . . . by remaining breastless is a throwback to the Middle Ages," Berger argued in one news release. She even went so far as to claim that banning implants would lead to an increase in cancer deaths among women. Without the implant option, she argued, women would avoid seeking diagnosis and treatment of their cancers.

One Hand Washes Another

Burson-Marsteller documents suggest that financial incentives helped Dow grease the skids with cancer support groups such as Y-ME and the Susan B. Komen Foundation. The Komen Foundation, for example, sponsors running marathons in several cities to fundraise and promote awareness of the need for breast cancer checkups. In an October 1991 strategy note, Burson-Marsteller noted that the foundation "wants Dow Corning to sponsor upcoming race in Atlanta."

B-M also offered its assistance on what it called an "I scratch your back" basis to the breast cancer coalition "to pump dollars for [breast cancer] research."

Some breast cancer survivors, such as Darcy Sixt, publicly acknowledged that they had become paid spokespersons for Dow Corning. Others either worked for free or made no mention of who paid them.

Although the hundreds of women who rallied during the Washington fly-in had their expenses paid, Burson-Marsteller planned to avoid payments to people who would be testifying before the FDA. It made a special exception to this rule in one case--Timmie Jean Lindsey, who in 1962 became the first woman to receive a set of breast implants. "We will be paying for Timmie Jean Lindsey to testify--based on the fact that she could not take on the financial responsibility," states a B-M document.

In fact, Lindsey's full story could strengthen the argument of women who say implants cause connective-tissue disorders. In the 1970s, she suffered joint pain, rashes, dry mouth, dry eyes, and chronic fatigue. More recently, she underwent surgery to replace a knee joint, a problem she attributes to age but which might be interpreted as a symptom of silicone-induced arthritis. Her daughter and a sister-in-law, both of whom she encouraged to receive implants, have joined the class action lawsuit that plaintiffs have filed against implant manufacturers, with her daughter alleging that the implants gave her lupus.

The plastic surgeons' efforts to recruit spokespersons backfired completely in the case of Terry Davis of Palm Beach Gardens, Florida. "My doctor told me to lobby the FDA to keep implants," she told the FDA panel. Instead, she attended so she could describe the complications she had suffered with her implants following a double mastectomy four years previously.

Bowing Out

In the March 1992 letter from B-M's Johnna Matthews to co-worker Larry Snodden, she credited Burson-Marsteller's grassroots strategy with "turning around the media coverage on the issue from strongly negative, to almost equal amounts of balanced and positive articles versus negative. It culminated briefly in November's FDA Advisory Panel Hearings where by bringing in a tremendous number of women to testify, we also helped turn those hearings around. The result was that the panel recommended to FDA Commissioner David Kessler that the implants remain on the market--a major victory."

Victory notwithstanding, Dow Corning was already outlining plans to withdraw from the breast implant market, which had become both controversial and unprofitable. In a strategy document dated December 19, 1991, Burson-Marsteller warned that "the company's motives are going to be questioned. You can't say in November, 'We are very concerned about the patients, and will do anything the FDA requires of us to keep the product widely available,' and then say in January, 'We are withdrawing from the marketplace.' "

From a PR perspective, B-M advised Dow that it could "minimize negative comments" by timing its withdrawal to coincide with an "adverse FDA decision" that could serve as "a highly defensible public reason for withdrawing from the business."

The anticipated "adverse FDA decision" came with two rulings in early 1992. Although Kessler made an exemption so that breast cancer patients could continue to receive silicone implants despite the ban, Dow's grassroots network continues to accuse the FDA of limiting options for breast reconstruction.

As recently as August 1995, Y-ME Executive Director Sharon Green testified before Congress that "The implant debate is out of control--and, as a result, we all lose." Another Y-ME activist, Rosemary Locke, described silicone implants as "a benefit to women not only in the breast cancer community, but to some degree to all women."

Cosmetic Reconstruction

In order to rehabilitate its battered image, Dow Corning reshuffled management in 1992, bringing in Keith McKennon as its new chairman. McKennon's background included crisis management for Dow Chemical during the parent company's own prior scandals. The Washington Post noted that McKennon had handled "public relations fights over dioxin and Agent Orange. . . . This background is very pertinent to a meaningful resolution of the mammary issue."

Dow also hired Griffin Bell, former U.S. Attorney General under President Carter, to perform an "independent review" of the company. Since leaving public office, Bell has performed similar high-profile services for clients including Exxon in the wake of the Valdez oil spill; General Motors after the discovery that pickup trucks were exploding in auto collisions; Virginia Military Institute in its effort to bar women students; and A.H. Robins during its Dalkon Shield controversy.

"What does the company need from Griffin Bell?" asked one Burson-Marsteller document. "Not a 'clean bill of health'--which would be a disaster." B-M even suggested toughening the Bell review by adding a "representative of a responsible public interest group" or a "major medical association. If the findings are a bit rougher than they might otherwise have been, from a PR perspective, that's not a problem. It gives the company a chance to show credibility, responsiveness, willingness to change."

Bell prepared a report based on his investigation, along with a three-page letter of recommendations for changes in company policy. Dow released the letter with an accompanying statement of the company's intent to comply with these "reforms." The statement claimed that Bell's team had exhaustively reviewed 300,000 pages of corporate information. Citing attorney-client privilege, however, Dow refused to release the documents for public review, or even to release Bell's full report.

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