Johnson & Johnson has had a good corporate reputation. In particular, the company has been much praised for its handling of the cyanide poisoning of Tylenol capsules in 1982, which has been used for a Harvard Business School case study. Gardiner Harris, a former pharmaceutical reporter for The New York Times, argues convincingly in his new book, No More Tears: The Dark History of Johnson & Johnson, that this reputation is undeserved. He offers detailed reporting about various J&J products, including Tylenol, baby powder, Risperdal, metal hip implants, and others.
It makes for very disturbing reading. For example, J&J tried to minimize the asbestos issue with talc in its baby powder, which eventually has been replaced with cornstarch. The chapter on Risperdal is especially disturbing. This antipsychotic drug with J&J’s encouragement, has been used in assisted care facilities to calm down those living there, an off-label use for which there is convincing evidence can hasten death. This drug has also been prescribed for children with problem behavior. However, this drug can cause disturbing weight gain, and some boys can develop breasts from taking the drug, for which they need to have surgery to remove.
As for the opiod crisis, while Purdue Pharma and the Sacklers have taken the lionshare of the blame, Harris points out that J&J was selling Duragesic, whose active ingredient is fentanyl, using the same arguments and marketing strategies as Purdue used to sell OxyContin. While fentanyl does not come from poppies, the active ingredient in OxyContin does, and J&J supplied the raw material for OxyContin and other opiod drugs to Purdue and others from a Tasmanian company it bought in 1982. After that purchase, J&J became the largest supplier of active ingredients from opium poppies in the United States to other drug manufacturers.
Harris also shows the effective marketing strategies J&J used to promote questionable uses of its products, including the charming pharmaceutical representatives who visit doctors, the rewards to doctors who write a large number of prescriptions for particular drugs, and the use of ghostwritten studies of particular products. Also, Harris argues that J&J had undue influence with the FDA, both because it could influence FDA appropriation decisions with Congress and could offer jobs to FDA employees when they decided to leave the agency.
To be fair to the FDA, Harris does provide instances when the FDA was trying to do the right thing even as it faced opposition from J&J. As for the pharmaceutical representatives, Harris says that some courageously blew the whistle on their employer and showed greater integrity than the people running J&J.
Unlike Patrick Radden Keefe’s book on the Sacklers and Purdue, Empire of Pain, Harris’s book does not provide the compelling, focused novelistic narrative as Keefe’s book. However, Harris’s book is decently written and is more disturbing from a public policy perspective. Purdue Pharma could be brought down, but that will not happen to J&J, which provides useful and beneficial medical pharmaceuticals and products. One suspects that J&J is not alone in using questionable tactics to sell its products, though they may be particularly good at public relations and lobbying.
Harris’s book has not reached the bestselling heights of Keefe’s book. That is too bad. It deserves greater attention.