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

by John C. Stauber and Sheldon Rampton

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.

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."

From Cover-up to Blow-up

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

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

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."

"These women (including celebrities)will be trained and testimony will be

writtenor them to deliver before Congressional committees."--internal

Burson-Marsteller PR document

 

"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] 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 spokersperson.

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

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

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]

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 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

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.