more confident that products were safer for children. the company was forced to release internal documents with 11,700 people suing j&j over cancers allegedly caused by baby powder. the documents showed that the company had known about asbestos contamination since at least as early as 1971 and had spent decades finding ways to conceal the evidence from the public. the company lost its request to reverse a jury verdict that ruled in favor of the accusers, which required the company to pay $4.14 billion in punitive damages and $550 million in compensatory damages. a large study performed in 2003 found that ovarian cancer risk increased from a baseline of 0.0121% to 0.0161% in people who reported regularly using talc in the genital area. two more studies over the next twelve years, which also relied on self-reporting, had similar results; however, none of the three studies showed a relationship between how long someone used talc and how much their cancer risk increased, which is expected in experiments with carcinogens and other toxic substances (see dose-response relationship). conversely, a st. louis jury ruled in favor of johnson & johnson in the case of a single plaintiff who had used the company's talc-containing baby powder for thirty years with a similar claim. the company's ceo, alex gorsky, declined to appear at a united states congressional hearing on the safety of j&j's baby powder and other talc-based cosmetics. j&j spokesman ernie knewitz said that the subcommittee had rejected the company's offers to send a talc testing expert or a j&j executive in charge of consumer products. in response to declining demand, j&j announced it would discontinue the sale of talc-based baby powder in the united states and canada in 2020, but would continue to sell it in other markets. in a statement, the company said that the existing retail inventory of the talc-based powder will sell until it runs out, while the company's cornstarch-based baby powder will continue to sell in the united states and canada. the supreme court of missouri refused to consider j&j's appeal of a $2.12 billion damages award to women who blamed their ovarian cancer on its talc-based products. the supreme court of the united states also refused to consider an appeal from j&j, leaving in place a judgment from a state appeal court that had cut the original award to $2.1 billion. two of the justices had to recuse: samuel alito because either he and/or his wife owning or recently owning stock in j&j, and brett kavanaugh, whose father led an industry group lobbying against safety warnings on talc products. representing the affected women during the trial, mark lanier remarked that the supreme court's decision sent "a clear message to the rich and powerful: you will be held to account when you cause grievous harm under our system of equal justice under law." j&j had argued that the combined claims in the st. louis trial were too different, yet the short jury deliberation and identical payouts were, therefore, a violation of the company's due process and also that the high punitive award was unconstitutional. in 2021, johnson & johnson subsidiary ltl management llc, using a process called a texas divisional merger, filed for chapter 11 bankruptcy in north carolina. the process allowed by texas law lets a company create a separate subsidiary to take over liabilities, with the existing company operating normally. the new company, with a different name, can locate in a state such as north carolina where bankruptcy laws are different, and then declare bankruptcy, paying less than the original company would have. in the case of ltl, a $2 billion trust will be created, compared to $25 billion if johnson & johnson had declared bankruptcy. according to the filing, a company known as old jjci took on the baby powder related liabilities in 1979, while johnson & johnson remained a defendant. ltl and new jjci were created with ltl taking the baby powder related liabilities and some assets, and new jjci taking the remaining assets. johnson & johnson says ltl is now based in new jersey. the company announced that it would stop making talc-based powder by 2023 and replace it with cornstarch-based powders. the company says the talc-based powder is safe to use and does not contain asbestos. in 2023, the number of lawsuits regarding talc-based baby powder has exceeded 40,000 as more claimants come forward to say that the company's product caused them to have cancer. johnson & johnson have now reportedly offered $9 billion to settle all the lawsuits against the company, up from the previous figure of $2 billion. opioid epidemic further information: opioid epidemic in the united states by 2018, the company had become embroiled in the opioid epidemic in the united states and had become a target of lawsuits. over 500 opioid-related cases have been filed as of may 2018 against j&j and its competitors. in idaho, j&j is part of a lawsuit accusing the company for being partially to blame for opioid-related overdose deaths. the first major trial began in oklahoma in may 2019. on august 26, 2019, the oklahoma judge ordered j&j to pay $572 million for their part in the opioid crisis, and in october j&j paid $20.4 million to two ohio counties fighting the opioid epidemic. in january 2022, johnson & johnson agreed to pay up to $5 billion as part of a $26 billion settlement which included mckesson, amerisourcebergen, and cardinal health. had the states gone to court, the companies could have faced up to $95 billion in penalties. northeastern ohio settlement in october 2019, the company agreed to a settlement of $20.4 million with two ohio counties – cuyahoga (cleveland) and summit (akron). the settlement allows the company avoidance of a trial accusing j&j and many other pharmaceutical manufacturers of helping to spark the us opioid epidemic. the trial was thought to be an indicator for thousands of opioid-related lawsuits against many drug manufacturers. the arrangement, which contains no admission of liability by the company, provides the counties $10 million in cash, $5 million for legal expenses and $5.4 million in contributions to opioid-related nonprofit organizations in the counties. public-private engagement johnson & johnson and its subsidiaries engage with the public and private sectors in a variety of settings including to promote research and development, academic funding, event sponsorship, philanthropy, and political lobbying. academia j&j is a matching gift donor to the institute for advanced study. activism j&j is a corporate partner of human rights campaign, a large lgbt advocacy group. j&j is a financial supporter of women deliver. political lobbying johnson & johnson is engaged in various forms of lobbying in the united states, canada and internationally, including through corporate philanthropy and membership in lobbying organizations. j&j is one of the largest donors to the foundation for the national institutes of health (fnih), having donated between $5–10 million from 2000 to 2020. j&j is a partner of the pandemic action network. j&j is a member company of pharmaceutical research and manufacturers of america (phrma), a trade association that lobbies the u.s. government on behalf of the pharmaceutical industry. phrma has offices in washington, d.c., japan and the united arab emirates. j&j is a member of the personalized medicine coalition, a medical research advocacy group that lobbies on behalf of the pharmaceutical industry to increase funding for personalized medicine research and development. j&j is a member company of the national pharmaceutical council (npc), a nonprofit that advocates for expanded research funding and innovation. research and development j&j has provided research grants and major funding to the c. d. howe institute.