Books that expose a trusted healthcare brand

In September 1982, a string of poisoning murders rocked the city of Chicago. The common element in these seven murders was their mode of delivering the poison—in each case, cyanide had been mixed in a bottle of Tylenol (very similar to what we call ‘paracetamol’ in India) capsules. The so-called ‘Tylenol scare’ was eventually addressed by its manufacturers, Johnson & Johnson, who recalled 31 million Tylenol bottles from the shelves. The medication was brought back to pharmacies only after the regular capsule was replaced by the ‘Tylenol gelcap’, a tamper-resistant gelatin-encased capsule. The move cost Johnson & Johnson an estimated $100 million, but they soon recovered all the market share they had lost at the height of the Tylenol scare. At the time, Johnson & Johnson generated considerable public goodwill with the first large-scale product recall in American history.

Fitting then, that Gardiner Harris’ The Dark Secrets of Johnson & Johnson begins with a deep dive into this fascinating chapter of corporate history. Harris shows us how the corporate giant’s role in the Tylenol affair might not have been as heroic or as ‘public-minded’ as it seemed at first glance. In fact, through archival extracts, fresh interviews and public domain data made available after Tylenol’s eventual 2010 recall, Harris shows us how the Tylenol strategy was essentially a PR coup rather than an act of corporate conscience.

Harris writes: “Those who attend graduate classes in business, communications, or medicine are still taught that Johnson & Johnson executives wrote the book on crisis response with their honesty and unselfishness in responding to an infamous Tylenol poisoning scare in 1982. Internally, the positive associations with both products have been vital in creating and sustaining unusually strong beliefs amongst the company’s employees that J&J is uniquely ethical and an abiding force for good in the world, faith that paradoxically gives license to lapses that might not otherwise be accepted.”

Across the rest of the book, Harris shines a timely light on a wide range of J&J’s corporate malfeasance—a massive cover-up of their Baby Powder’s links to cancer, their contribution to America’s opioid crisis, an aggressive marketing campaign for an anti-psychotic drug that allegedly caused a wave of suicides among users, and so on. The decades-spanning list runs long and grows bleaker with every chapter.

To his credit, Harris gives every single one of these issues the space that they deserve (even at the cost of editing hygiene—this 400-plus page book could easily have shaved a hundred-odd pages off its length). Patterns of corporate behaviour emerge readily—J&J seems to target litigants based on their means, they are also less or more aggressive with governments based on the size of their respective economies. Marketing and strategy documents have a way of disappearing, and court testimonies offered by their executives are usually a masterclass in the now-infamous “3D” (delay, deny, depose) line of attack.

Towards the end of the book, in a chapter with a rather colourful title (‘Gods, Nazis and Hip Implants’), Harris describes how J&J allegedly bribed influential doctors and surgeons to push their new metal-on-metal hip implants.

Their metal-on-metal ASR (Articular Surface Replacement) hip implant is the focus of another recent book on J&J; Kaunain Sheriff M’s The Johnson & Johnson Files. This is an old-school book of dogged, old-school investigative journalism by Sheriff, who is the national health editor at The Indian Express. The author’s reports were part of a global investigation by the Pulitzer-winning group ICIJ (International Consortium of Investigative Journalists). If Harris’ book told us J&J’s modus operandi in the West (bribing, finessing, legal manoeuvring) Sheriff’s work shows us some very different methods allegedly applied in India (obfuscating data, hiding patient records, ignoring lower court orders).

According to Sheriff and the evidence he presents here, J&J continued to aggressively market their faulty hip implants to Indian doctors and patients. This, even after they had received adverse feedback and alarming failure rates in Australia and the UK. In 2012, the UK’s House of Commons set up a committee to decide whether the country’s existing laws on patient safety were adequate when it came to assessing the latest medical implants and devices. This decision itself was prompted in part due to public outcry, after a string of botched hip replacement procedures across the country. One of the experts who testified before this committee, Tom Joyce, is quoted at length in The Johnson & Johnson Files.

At one point, Joyce says, “Once an implant is inside a patient, it’s like setting a ship to sea—what’s done is done. The real opportunity to prevent harm is before that, during pre-market testing. It’s about conducting robust tests with advanced equipment and making those results publicly available. That way, independent experts can scrutinize the data and flag any potential red flags. Pre-market testing is a crucial piece of the puzzle.’”

This extended section, featuring Joyce and a couple of other experts, tell the reader two very important things about pre-market testing. One, due to the lobbying efforts of pharma giants worldwide, pre-market testing data is usually classified as “commercial in confidence” i.e., it cannot be shared with the public. It is essentially the same classification that, say, Coca-Cola uses to keep the soft drink’s recipe a secret. Two, the gaps in pre-market testing are due to several factors—but a lack of resources or technology isn’t one of them. The first ‘hip simulator’ used to test devices like the ASR was built way back in 1966. In the decades since then, the process of testing artificial hips has become smoother, faster and more thorough by orders of magnitude; companies can now plausibly test up to a dozen artificial hips at once.

The Johnson & Johnson Files straddles several different nonfiction genre staples—medical drama, courtroom thriller, corporate espionage. But in my view, it is at its strongest when it focuses on that hoary old chestnut of journalism, the ‘human interest’ story. When we meet Daisy Bharucha, the woman whose case against the company would snowball into a landmark ruling, we cannot help but root for her plucky spirit and incorrigible sense of purpose. We want to see her achieving justice not just for herself but for all the other suffering patients like her, who had to undergo procedure after procedure, to reverse the harms (dislocation, metal particles entering the bloodstream) inflicted by the ASR implant.

“For those whose lives have been upended, whose health and dreams have been shattered, the wait itself is yet another injustice. The ASR hip implant saga has exposed some hard truths about our healthcare system. It’s shown us just how easily things can go wrong when patient safety takes a backseat. But the bigger question is, have we learned anything from this? Or are we still allowing the same mistakes to happen, leaving vulnerable patients to bear the brunt?”

Together, Sheriff and Harris’ books paint a troubling picture of J&J’s corporate practices. They remind us of the dangers of leaving medical innovation entirely in private hands. At some point, profits will override the well-being of patients, which is exactly what happened here and unless governments the world over take strong, concrete counter-steps, it’s exactly what will happen again and again.