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.