64 pages • 2-hour read
No More Tears: The Dark Secrets of Johnson & Johnson
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The Disparity Between Public Image and Internal Practices
Content Warning: This section of the guide includes discussion of physical illness, mental illness, and death.
The key theme in No More Tears is the difference between the public perception of Johnson & Johnson as a safe, reliable, ethical company and its unethical, sometimes criminal, internal practices which endangered consumers. This theme is well-illustrated in the title itself: No More Tears is a reference to the marketing of J&J’s baby shampoo, widely seen as a product safe for infants. However, like J&J’s Baby Powder, there are increasing concerns about whether that claim is, in fact, true. Throughout the book, author Gardiner Harris describes J&J’s public image and how it differs from its corporate practices.
Harris emphasizes that J&J is “the quintessential American story” (xvii). He notes that it is widely seen as “mother, medicine, and money all rolled into one” (xv). He describes how the company “has long been seen as a paragon of ethics” because of its “credo […] that J&J will never put profits before people” (xv). He argues that this highly positive image is bolstered by J&J’s careful reputation management. For instance, he notes that the company receives “overwhelmingly positive press coverage” because they “kill critical stories by threatening media outlets with financial ruin” by pulling ads (80).
Further, the company only grants interviews to friendly television news outlets like ABC, as the one-time J&J CEO James Burke’s brother was an executive there. They also carefully control and craft scientific information and data about their products by sponsoring favorable “studies,” continuing education for physicians, and other manipulative approaches. For instance, when concerns about asbestos contamination grew, J&J resolved to create “a talc testing standard that would be widely perceived as stringent but wouldn’t actually find asbestos when it was present at concerning levels” (41).
This carefully-crafted image bolstered by the perceived safety of J&J’s products belies the unethical and sometimes illegal behavior of the company’s actions. There are too many examples of this behavior to list them in their entirety here. Indeed, Harris himself recognizes that “as a many-tentacled conglomerate, Johnson & Johnson’s history is exceedingly complicated and difficult to tell” (xvi). Some of the key examples covered in No More Tears are hiding and destroying evidence of asbestos contamination in Johnson’s Baby Powder, illegal marketing of dangerous medications like Risperdal and Procrit to vulnerable populations, Medicare / Medicaid fraud, selling products without FDA approval, hiding evidence of adverse events from the FDA, false advertising, and more.
The term used repeatedly by Harris to describe this behavior throughout is “shady.” He thus consistently stresses that J&J used its overwhelmingly positive public image to provide cover for its “shady” actions.
Regulatory Challenges and Governmental Oversight
Gardiner Harris focuses on how the government, particularly the Food and Drug Administration, is unable and unwilling to effectively fulfill its mandate to protect consumers from Johnson & Johnson’s dangerous medicines, consumer products, and/or medical devices. Harris argues this state of affairs is due to insufficient statutory mandate, chronic underfunding, and regulatory capture. He also illustrates briefly how Johnson & Johnson lobbies government officials to ensure favorable treatment. Throughout the text, Harris aims to spotlight regulatory challenges and the importance of effective governmental oversight.
Harris argues that the role the FDA plays is crucial because it nominally has regulatory authority over many Johnson & Johnson products. However, this authority is statutorily highly limited. For instance, as Harris notes, the 1938 Food, Drug, and Cosmetics Act only required the FDA to test “whether a drug was safe, not whether it was effective” (37). This was not changed until the 1962 Kefauver-Harris Amendments. However, even with these reforms, cosmetics like baby powders were left to a small office within the agency to address.
This issue points to the ongoing funding strain and understaffing issues that the FDA faces. Harris notes that the FDA did not get involved in the criminal investigation of the 1982 Tylenol poisoning case because they did not have the resources to do so; he notes “it quickly surrendered the role of testing Tylenol bottles for cyanide to Johnson & Johnson” (101). The ongoing funding woes led the FDA to strike a deal with corporations: In 1992 FDA commissioner David Kessler “made common cause with the drug industry […] to start paying massive user fees directly to the FDA” (134).
This funding model contributes to the regulatory capture of the agency, where corporations are effectively able to control their own regulation. This is managed through the payment of the user fees in exchange for favorable treatment, such as when Johnson & Johnson ensured high fees would be paid to the FDA seemingly in exchange for their medical devices not being pulled from the market. It also occurs though a “revolving door” process whereby FDA commissioners come from and/or go to work for Johnson & Johnson or other large medical conglomerates before or after their tenure at the agency.
Harris also briefly notes how Johnson & Johnson lobbies state governments to ensure a favorable environment for them at the state and local level in his discussion of J&J’s aggressive marketing of Risperdal. He describes how J&J directly paid state Medicaid directors in Texas, Kentucky, and elsewhere in exchange for them instituting an algorithm that would privilege the prescription of Risperdal instead of cheaper medications like Haldol for the treatment of schizophrenia. J&J also contributed to political campaigns of “crucial legislators” in state houses to encourage the passage of “laws specifically exempting drugs treating mental disorders from cost controls” (174).
As a result of these lobbying efforts and FDA capture, J&J feels it can operate however it wishes without fear of serious consequences outside of civil litigation brought by private plaintiffs. In response, Harris emphasizes at the end of the text the importance of making the FDA entirely taxpayer-funded to avoid conflicts of interest and to ensure the FDA is more stringent in its handling of medical companies.
The Lack of Corporate Ethics and Accountability
Harris uses evidence from trial proceedings, including sealed grand jury proceedings, and internal Johnson & Johnson documents to build an argument that, in the modern era, Johnson & Johnson operates with a lack of corporate ethics and accountability.
The range of corporate malfeasance Harris describes runs a large gamut. Some of their actions were illegal, including hiding evidence from the FDA, submitting falsified affidavits to the court (which amounts to lying under oath), and false advertising. Other actions were simply unethical, such as human testing and pushing to market drugs to vulnerable populations who they knew could die or be severely injured by the products. Harris also illustrates how the company fails to hold executives accountable for these actions with the example of J&J salesman-turned-executive Alex Gorsky, who continued to rise up through the company despite his role in many of the unethical actions summarized above.
Harris’s language when describing the illegal activities of J&J executives is unequivocal and damning. For instance, he notes that the company continued to deny the presence of asbestos even “as evidence mounted” (29). He highlights “that statements made under oath by a top company executive […] were false” (29, emphasis added). J&J’s decision to inappropriately market Risperdal to vulnerable elderly and child populations under the “Sell to the Symptoms” scheme was likewise illegal and resulted in excess death and strokes in the elderly and metabolic issues in the young. Harris uses his unprecedented access to grand jury proceedings, which are typically private, to note that “Johnson & Johnson’s own regulatory experts told the grand jury that they knew a symptoms-based message was illegal” (167).
In other instances, J&J’s activities were simply unethical, if not illegal. Perhaps the most significant example of this is the account of the discussion of J&J’s contract with Dr. Kligman to “conduct[] tests of Johnson’s Baby Powder […] on African American prisoners and mentally disabled children” (32) that included injecting Black prisoners with asbestos. A similar scandal is J&J’s decision to sell Prolift vaginal mesh “without asking the FDA for approval” (298). While not strictly illegal, this unethical decision led to horrific side effects in people who were implanted with the vaginal mesh, as the product eroded through the vaginal walls.
Harris uses the example of Alex Gorsky’s rise through the company to illustrate how J&J rewards this corporate malfeasance rather than hold those responsible for the behavior accountable. He notes that Gorsky “took over the marketing of Risperdal” (170). While Gorsky did briefly leave the company during a federal investigation into the illegal marketing tactics, he returned only four years later “at an even higher executive level” (213). Gorsky was also involved in the development, marketing, and ensuing scandals of other products covered in No More Tears, namely Duragesic, the Covid vaccine, vaginal mesh, and the Pinnacle hip implants. He retired as Johnson & Johnson CEO in 2022 without facing any legal or professional consequences for his actions. Indeed, he was rewarded for the sales growth he brought to the company through his illegal and unethical actions.
In highlighting the lack of corporate ethics and accountability at Johnson & Johnson, Harris thus hopes to expose how major medical companies can often get away with illegal or unethical practices in the pursuit of profit. Documenting such abuses is meant to strengthen his complementary argument that such companies are in need of proper oversight, and that they should be held accountable when they cause death and injury to patients.
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