No More Tears: The Dark Secrets of Johnson & Johnson

“Johnson’s Baby Powder and Tylenol are among the most beloved and iconic consumer products ever sold. They largely define Johnson & Johnson’s image and have long provided the company with a protective halo of affection from consumers, professionals, and government officials.”

Harris begins his account with descriptions of how Johnson & Johnson failed to ensure the safety of its two “most beloved and iconic consumer products,” baby powder and Tylenol. His emphasis on these two products highlights the extent to which J&J’s unethical and illegal behavior extended even to its most trusted products, introducing the theme of The Lack of Corporate Ethics and Accountability. Harris argues these products conferred a near sacred quality (“a protective halo”) to the company as a whole, one that shielded it from scrutiny.

“A consistent theme throughout this book is how unsurprising so many findings were, given previous research—and that the earlier research had been ignored or essentially suppressed by those whose business interests would be impacted by awareness and regulation.”

As noted elsewhere in this guide, Harris relies heavily on previous reporting and research in his exposé of J&J. Here, Harris acknowledges this himself. He further argues that “business interests” used their power to minimize not only Regulatory Challenges and Governmental Oversight of this unethical or illegal behavior, but also public awareness of the “unsurprising” claims he makes in No More Tears.

“What the industry needed was a talc testing standard that would be widely perceived as stringent but wouldn’t actually find asbestos when it was present at concerning levels.”

This is one example Harris provides of how Johnson and Johnson avoided Regulatory Challenges and Governmental Oversight by shaping how data was reported to the FDA. This quote is also an example of how Harris uses internal documents throughout to build his argument that J&J and other medical companies knowingly acted to mislead the public and regulators. In the endnotes, he links to a 1974 memo with J&J letterhead that directly states exactly what Harris claims here.

“To this day, asbestos is linked to about forty-thousand cancer deaths in the United States every year, or about the same toll as breast cancer. With every passing year, Johnson & Johnson’s deceit not only killed and sickened more people but promised an ever greater shock when revealed.

Doing anything that might reveal this fact may have seemed unthinkable. Another puzzle is why the FDA didn’t take a stand.”

Harris’s language here is somewhat unclear, but he is describing how the longer Johnson & Johnson failed to address issues with its talc-based baby powder, the harder it became for them to shift to a corn powder-based baby powder without admitting fault for the deaths due to asbestos-linked illnesses that they had knowingly caused. Harris speculates here that admitting fault on this scale “may have seen unthinkable” to executives involved in the decision-making around the issue, because the financial fallout would have been substantial.

“The FDA’s 2014 talc statements were part of a long pattern that would continue for years in which the FDA issued statements that were tailor-made to help J & J fend off legal claims. (Several came after 2012, when J & J’s chief executive used his industry and political connections to save hundreds of FDA jobs, a story discussed later in the book.) Bolstered by the FDA’s endorsement, J & J’s Baby Powder business continued to flourish—but not for long.”

This quote illustrates the close connections between the FDA and J&J, invoking Regulatory Challenges and Governmental Oversight. As elsewhere, Harris suggests that the FDA’s willingness to “fend off legal claims” for J&J stems from the regulatory capture resulting from J&J’s role in funding the FDA. Harris emphasizes that this is not a one-time quid-pro-quo but rather “part of a long pattern,” suggesting a total breakdown of governmental oversight.

“For most of J & J’s modern history, the company had received overwhelmingly positive press coverage, in part because of the firm’s massive advertising budget. Again and again, the company was able to kill critical stories by threatening media outlets with financial ruin. It had done so at the local and national levels.”

Harris uses forceful language to drive home J&J’s ability to control its public image, highlighting The Disparity Between Public Image and Internal Practices. He writes that the company “was able to kill critical stories,” a term that alludes to the actual deaths for which the company is liable. Media companies would not just lose money as a result of J&J’s actions but face “financial ruin,” a dramatically worse state of affairs. Harris uses this kind of strong language throughout the work to highlight the stakes of the problems he is describing.

“This is why most histories of the 1982 case end on an upbeat note: A tragedy causes an entire industry to change for the better. It’s a good story, and mostly an accurate one, that leaves J & J covered in plaudits.

But there are a few flaws in this happy narrative, including an account of a stone-cold killer with easy access to J & J’s distribution system. Taken together, these footnotes to the oft-told tale about 1982 cast J & J’s handling of the episode in a somewhat less commendable light.”

This passage highlights one of the clearest examples of The Disparity Between Public Image and Internal Practices in No More Tears. Harris critiques the “happy narrative” of the mainstream account of the 1982 Tylenol poisoning and foreshadows that he will be reanalyzing it to illustrate how J&J is at least partially at fault for what occurred. This is one of the bolder claims Harris makes throughout the book, as J&J has long been cleared of liability by most mainstream accounts due to this “good story.”

“‘It was a bitter irony that the gentle, loving relationship between mother and child should somehow be a factor in the comeback phase of a crime of evil-minded brutality,’ wrote Lawrence G. Foster, the company’s longtime public relations chief. The real irony, of course, is that one contaminated product helped the company recover from another.”

Although Harris deals with the nine J&J products in turn, this quote illustrates how the individual scandals he details occur simultaneously and interact with one another as part of a larger web of malfeasance. In this case, the public was primed to feel warmly about J&J and their handling of the Tylenol poisonings because they had warm feelings about Johnson & Johnson’s Baby Powder, “which J&J was still lying about” (99).

“Every FDA commissioner of the modern era has worked for drugmakers after leaving government service, and many worked for them beforehand. But only Dr. Arthur Hayes, Jr., surreptitiously and illegally took money from drug companies while he led the agency.”

Harris here details how regulatory capture works, at least in part—companies directly hire FDA commissioners before and/or after they take the role. This is just one example of how Regulatory Challenges and Governmental Oversight of medical companies is a systemic issue that goes beyond J&J and extends to the sector as a whole.

“Documents revealed in Benedi’s case showed that Johnson & Johnson had known for years that moderate drinkers—a description that applies to most Americans—could suffer catastrophic liver damage from ordinary doses of Tylenol.”

Harris’s discussion of Benedi’s case and the risks of Tylenol overdose in moderate drinkers illustrates how Harris relies on previous investigative reporting to build his argument about The Lack of Corporate Ethics and Accountability at J&J. Instead of conducting his own reporting here, Harris draws from an extensive report from the non-profit investigative reporting outlet ProPublica. This further illustrates the argument Harris makes in Important Quote 3: That much of the information in No More Tears is already publicly available.

“So drugmakers began cajoling doctors to use medicines more often and in more patients than was prudent or strictly legal. Even in the early 1980s, J & J was pushing these boundaries. And as the decade went on and the company’s labs and those of its partners started to stumble, the pressure to push the boundaries of ethical marketing practices increased.”

As elsewhere, Harris makes clear that J&J is not alone in acting unethically. He writes that both J&J and “its partners,” meaning other companies in the prescription drug market, all “push[ed] the boundaries” of legal behavior. However, he subtly signals that even amongst a cohort of bad actors, J&J was particularly unethical as “even” early on in this trend: J&J was a forerunner in this behavior, emphasizing The Lack of Corporate Ethics and Accountability at the company.

“Drugmakers soon learned that they could jawbone the agency for months while a misleading ad campaign continued uninterrupted, and J & J was among the best at this. The back-and-forth allowed the ads to be seen by millions more before they were finally pulled.”

Harris illustrates over and over again how the FDA acts too slowly to effectively regulate unethical or illegal actions by J&J and other medical companies, spotlighting Regulatory Challenges and Governmental Oversight. The use of the term “jawbone” implies that J&J is intentionally wasting the FDA’s time by insisting on petty, immaterial arguments.

“There are many moments in the history of American healthcare that are difficult to explain in retrospect. The opioid and antipsychotic disasters in the late 2000s and early 2010s—long after the dangers of these medicines were clear—are among the more well-known.

But just as inexplicable was the growth in EPO prescriptions after the FDA advisory committee made the drug’s dangers plain. Both the opioid and EPO disasters resulted in large measure from the financial incentives in the American system.”

Harris here draws a line connecting two high-profile medical scandals, that of the opioid epidemic and the overprescription of antipsychotic medications to children and elderly, to a less well-known medical scandal, that of EPO overprescription and resulting Medicare/Medicaid fraud. He asserts that all of these scandals are tied to systemic failures resulting from “financial incentives in the American [medical] system.” This illustrates how J&J is just one of many bad actors within that system.

“The Biederman case demonstrates not only how thoroughly drugmakers can fool an entire medical specialty but how persistent the resulting mythology can be. Despite a cascade of subsequent revelations that emerged during litigation demonstrating his terrible medical ethics, Biederman’s studies remain among the most often cited and admired in child psychiatry.”

Although Harris focuses on The Disparity Between Public Image and Internal Practices as it relates to Johnson & Johnson, this passage illustrates how such discrepancies also persist when it comes to other leaders in the medical field, such as Dr. Biederman, who wrongfully asserted for decades that children as young as one or two years old could be diagnosed with bipolar disorder and treated with “powerful medicines” like Risperdal in exchange for kickbacks from J&J.

“Then there was the ‘ethical/moral’ slide. Instead of addressing the ethical and moral aspects of illegally selling a harmful drug, it noted that ending the company’s marketing of Risperdal’s use in the elderly population would ‘relinquish obligation to patients, caregivers & providers.’ That is, that J & J had a moral obligation to continue marketing Risperdal for the elderly because otherwise the company would be seen as abandoning a needy population.”

Harris here notes that J&J executives transformed the meaning of “ethical and moral.” A conventional understanding of the term in this context would indicate the ethical need to address the dangers of Risperdal to the elderly. However, to J&J executives, it referred to the obligation to continue providing the drug to the elderly despite its growing knowledge of risks of strokes, heart attacks, or even death, reflecting The Lack of Corporate Ethics and Accountability at the company.

“The perceived inequities of the letter so outraged the Risperdal team that they undertook something that has never been done before or since: the exact opposite of what the FDA ordered the company.”

Throughout No More Tears, Harris illustrates how J&J escalated in its efforts to evade Regulatory Challenges and Governmental Oversight by the FDA over the decades. This quote represents the apex of that process where J&J deliberately did “the exact opposite” of what they had been ordered to do. The use of the word “exact” emphasizes the deliberateness and impunity with which J&J acted in this instance.

“But now that the world had finally been told the truth about Risperdal and the elderly, could the company possibly continue to send sales reps into nursing homes to push the drug onto this exceptionally vulnerable demographic?

Of course it would.”

Harris asks a rhetorical question to highlight his argument about the extent to which J&J is comfortable with acting unethically. His question frames what the seemingly ethical action would be: To stop marketing Risperdal to elderly people. He then responds to his own question to sardonically comment that “of course” J&J would continue to act unethically.

“Thousands of stories and an entire shelf of books have since been written about the opioid epidemic, but it’s remarkable how many of the crucial elements of this uniquely American disaster—payments to doctors, FDA failures, co-optive patient advocacy, and Sackler wealth—were captured in those first pieces.

That the epidemic nonetheless continued to build despite the press’s strident warnings is one of the most astonishing governance and law enforcement failures in American history. And one of the principal reasons for this failure was the actions of Gorsky and his team at Johnson & Johnson.”

Generally, Harris is very critical of the media and its lack of investigative reporting into the actions of medical companies like J&J throughout No More Tears. However, when it comes to the opioid epidemic, he praises local reporters at newspapers like the Portland Press Herald and The Roanoke Times for their early attention to this growing crisis. He argues that the failure in that case is not one of the media failing to warn the public, but rather a failure of governmental oversight and J&J’s corporate ethics.

“To be fair, the FDA is now so wholly captive to those it supposedly regulates that agency officials routinely refer to drug and device companies as their main customer and concern, not consumers or the American public. Even so, the agency’s deference to J & J has been remarkable.”

At points, as in this quote, Harris argues that the FDA has failed to fulfill its mandate to regulate drug and device companies. However, he consistently emphasizes that even within this corrupt system, J&J has a “remarkable” level of control that differs from even other drug companies like Merck or Purdue Pharma. This passage therefore highlights the issue of Regulatory Challenges and Governmental Oversight.

“What J & J didn’t tell the FDA was that the company was sitting on dozens of additional revisions and complaint reports that it had never forwarded to the agency. (Federal law requires companies to forward such reports to the FDA in an expeditious manner.) So the FDA’s reassurance that Pinnacle seemed to be performing well resulted because the company had illegally kept the agency in the dark.”

Harris uses the term “illegally” to characterize J&J’s decision to hide unfavorable results of its metal-on-metal hip implants from the FDA. This is a bold claim that Harris is able to make because of the findings of a court decision regarding this practice which he cites in the endnotes, Andrews v DePuy Orthopaedics. Harris reproduces long excerpts of the court transcripts to justify this claim; In 2016, the jury found in the plaintiffs’ favor and awarded more than $1 billion in damages.

“But in both cases the company never conducted an actual clinical trial before launch that demonstrated these dangers. So executives had some small amount of wiggle room to claim that they didn’t conclusively know that the products were killers. With J & J’s vaginal mesh, however, that wiggle room disappeared. And rather than lie to the FDA about these proven dangers, the company simply didn’t consult the agency at all.”

This is another example of Harris’s argument that J&J progressively escalated in its efforts to avoid government oversight. The Prolift vaginal mesh scandal is the second-to-last topic covered in the book; the structure implies that eventually J&J “simply” began to put products on the market without bothering to get government approval.

“Executives had known for decades that if Americans ever found out that the company deliberately violated the emotional bond created between Johnson’s Baby Powder and the public, the consequences to the company’s brand could be catastrophic.

Hell hath no fury like a consumer scorned.”

In this quote, Harris riffs on the William Congreve quote from The Mourning Bride (1697), “hell hath no fury like a woman scorned,” meaning that no one is angrier than a woman who has been rejected. He uses this structure to describe how J&J executives worried, rightly, that costumers would be furious when they discovered how carcinogenic their talc Baby Powder was.

“Nothing better encapsulates the more-than-140-year history of Johnson & Johnson than having its leader be rewarded and publicly celebrated for actions that in reality helped to foster or worsen the country’s worst public health crises. Few companies in American history have had a wider gap between their public reputation and their actual conduct than J & J—a gulf it bridged with enormous advertising budgets, ingenious public relations campaigns, and massive piles of money.”

Here, Harris summarizes his argument about The Disparity Between Public Image and Internal Practice. He alludes to the irony of J&J being “publicly celebrated” for its role in developing a Covid-19 vaccine even as its efforts ultimately contributed to vaccine skepticism due to the side effects of the J&J vaccine.