No More Tears - Book Summary
The Dark Secrets of Johnson & Johnson
Book by Gardiner Harris
Summary
Behind the trusted baby powder and beloved Tylenol lies one of the most shocking corporate deceptions in American history—how Johnson & Johnson knowingly sold dangerous products for decades while building a reputation as the most ethical company in healthcare.
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Trust Is Our Product
Johnson & Johnson's most powerful branding weapon isn't advertising or marketing—it's a distinctive fragrance with over two hundred ingredients from around the world. The complex floral scent combines vanilla, jasmine, lilac, rose, musk, and citrus to create the most recognized fragrance globally. This scent imprints itself on infants before birth and throughout childhood, creating what J&J calls 'the Golden Egg'—an emotional bond between mothers, babies, and the J&J brand.
This emotional programming operates at the deepest level of human psychology, feeding directly into the brain's limbic system. Unlike competitors who achieve only 'rational trust,' Johnson & Johnson uniquely possesses 'real emotional trust' that consumers will forgive missteps and brand crises. The investment in this psychological manipulation pays enormous dividends—creating a protective halo around all J&J products for life.
Section: 1, Chapter: 1
The Myth Of FDA Protection
J&J's most powerful defense isn't legal—it's mythological. The company successfully portrays the FDA as a 'tough cop' that protects Americans from dangerous drugs. This myth serves multiple purposes:
- Reassures sales reps their activities must be legal ('the FDA wouldn't allow it')
- Convinces doctors that FDA approval equals safety
- Provides legal immunity in many states
- Makes Americans willing to try new drugs faster than other countries
In reality, the FDA is industry-captured, understaffed, and reactive. Most enforcement comes from whistleblowers, not agency action.
Section: 1, Chapter: 1
The Quintessential American Story
CNBC's Tyler Mathisen called J&J 'quintessentially American'—and he was right. The company's story mirrors American healthcare's transformation from best to worst, protected by myths and money.
J&J represents everything wrong with American capitalism: regulatory capture, institutional corruption, and the prioritization of profits over people. Despite causing potentially millions of deaths through its prescription drugs, the company maintained its reputation through massive PR campaigns and strategic donations. Its ability to avoid accountability while being celebrated as ethical demonstrates the fundamental corruption of American systems.
Section: 1, Chapter: 1
Three Brothers Go To New Brunswick
The Johnson & Johnson story began when Robert Wood Johnson, sent away from Pennsylvania to avoid Civil War service, learned the mysterious art of medicinal plasters in New York. He partnered with George Seabury in 1873, then struck out with his brothers to found Johnson & Johnson in 1887.
Their breakthrough came through relentless innovation in rubber-based plasters that could both stick and keep. Combined with early adoption of antiseptic practices inspired by Joseph Lister, the company built a global empire of sterile medical supplies. By 1911, J&J produced 90% of the world's sterile cotton, gauze, and bandages.
Section: 1, Chapter: 2
The Mineral Twins That Changed Everything
Talc and asbestos are geological twins—chemically similar minerals that often form together in the earth. The key danger lies in their proximity: talc deposits are frequently sandwiched between or ribboned with asbestos veins, making complete separation impossible.
When J&J bought Vermont talc mines in 1964, they positioned themselves just yards from asbestos mines. The company discovered their talc contained 'less than 1% to about 3% of contaminants'—mostly asbestos. This contamination would haunt the company for decades, as even microscopic asbestos fibers can cause cancer decades after exposure.
Section: 2, Chapter: 3
How The FDA Became Powerless
The FDA was born toothless in 1906, able only to verify ingredient lists on patent medicines. It took the horrific deaths of 73 people from poisoned Elixir Sulfanilamide in 1937—including six-year-old Joan Nidiffer—to give the agency power to test drug safety. The thalidomide crisis then mandated efficacy testing.
But cosmetics like Johnson's Baby Powder fell into a regulatory black hole. Despite being used by millions daily, cosmetic products needed no FDA approval and the agency had minimal resources to study them. As one official noted: 'Nobody dies from cosmetics.' This blind spot would prove catastrophic.
Section: 2, Chapter: 5
Manufacturing False Safety Standards
When facing potential regulation, J&J didn't fight the FDA—it captured the standard-setting process. The industry created the J4-1 testing method, designed to look sophisticated while being incapable of detecting asbestos contamination.
The method was like 'using a bathroom scale to weigh a pin.' Labs tested with J4-1 failed to detect even deliberately spiked samples containing asbestos. Four labs missed all fourteen spiked samples; others caught only three. Despite these obvious failures, the industry adopted J4-1 unchanged, giving companies a scientific-sounding way to declare products 'asbestos-free' while knowing they contained the deadly mineral.
Section: 2, Chapter: 6
The Power Of Institutional Pressure
When Harvard's Dr. Daniel Cramer published evidence linking talcum powder to ovarian cancer, J&J deployed its most effective weapon: institutional capture. Company executives flew to Boston and pressured Dr. Thomas Chalmers, president of Mount Sinai Medical School, to issue a public retraction of his own faculty's research.
Chalmer's initial defense of the research was stripped away line by line until the final statement contradicted the science. This wasn't just about one study—it was about demonstrating that even elite medical institutions would bend to corporate pressure. The tactic worked so well that it trained a generation of journalists to be skeptical of any claims about baby powder contamination.
Section: 2, Chapter: 7
Secrecy As Corporate Strategy
When a worker died from mesothelioma linked to J&J's former talc mine, the resulting legal discovery threatened to expose decades of cover-ups. J&J's response revealed its sophisticated approach to damage control through secrecy:
- Document purges to destroy evidence
- False affidavits swearing asbestos was never found
- Threatening plaintiffs' attorneys with sanctions
- Creating fake records to replace real ones
This pattern—deny, destroy, and threaten—became J&J's standard playbook for managing scandals across all its product lines for decades.
Section: 2, Chapter: 8
The Texas Two-Step And Avoiding Justice
When Baby Powder lawsuits threatened real accountability, J&J pioneered a legal maneuver called the 'Texas Two-Step.' The company:
- Transferred all Baby Powder liabilities to a subsidiary (LTL Management)
- Put $2 billion in a trust fund for litigation costs
- Declared the subsidiary bankrupt despite J&J's $400+ billion market cap
This allowed the company to cap damages and eliminate punitive awards from outraged juries. Though courts eventually rejected this scheme, it demonstrated J&J's willingness to push legal boundaries just as aggressively as it had pushed medical and ethical ones.
Section: 2, Chapter: 9
Sacred Cows Don't Die Easy
When the truth about Johnson's Baby Powder finally emerged in court, the evidence was overwhelming. Attorney Mark Lanier presented a devastating case: J&J knew for decades that Baby Powder contained asbestos, hid this from regulators, and continued selling while thousands of women developed cancer.
The jury awarded $2.5 billion in punitive damages—one of the largest civil judgments in history. Even after appeals reduced it to $2.1 billion, the Supreme Court upheld the verdict. J&J transferred the money within a day, but the company's 'sacred cow' was finally dead. Baby Powder sales were discontinued globally by 2023.
Section: 2, Chapter: 9
Manufacturing A Poisoning Myth
The 1982 Tylenol poisoning case created the most powerful corporate myth in American business history. But the accepted narrative has critical flaws: Tylenol had been tampered with hundreds of times before. The prime suspect—Roger Arnold—worked for J&J's distribution partner and had access to wholesale Tylenol boxes found scattered in a parking lot before the first death.
The FBI ignored these clues, focusing instead on a con man who sent an extortion letter. Arnold later murdered another man, validating investigators who believed he was the Tylenol killer. If true, J&J wasn't an innocent victim but a company whose compromised distribution system enabled mass murder.
Section: 3, Chapter: 10
When The FDA Goes Missing
During the Tylenol crisis, the FDA immediately absolved J&J of responsibility and surrendered its investigative role to the company itself. This wasn't objectivity—it was capture.
The corrupt commissioner Arthur Hayes took illegal payments from drugmakers while in office. He used the crisis to create a 'love fest' with J&J, issuing statements designed to shield the company from liability. The agency even officially dismissed the possibility that contamination occurred in J&J's distribution system—despite evidence pointing exactly there.
Hayes retired in disgrace but spent his remaining years working for a PR firm owned by a former J&J executive.
Section: 3, Chapter: 12
The Cost Of Doing Business
When asked about continuing to sell infant Tylenol despite babies dying from dosing mix-ups, McNeil's medical director revealed the company's calculation:
'Rather than pull the products off the shelf, that's sort of the cost of doing business?'
'McNeil felt that the benefit... was appropriate to keep it in the marketplace, yes.'
This became J&J's standard approach: factor potential criminal penalties into business costs and continue selling deadly products because the profits exceeded any punishment. Between 2010-2021, J&J spent $25 billion on litigation—a small price for avoiding real accountability.
Section: 3, Chapter: 13
The Deadliest Over-The-Counter Drug
Tylenol kills at least 150 Americans annually and hospitalizes 30,000—more than all other over-the-counter pain relievers combined. The drug's safety margin is uniquely narrow: the maximum daily dose is also the maximum safe dose.
Unlike aspirin or ibuprofen, acetaminophen provides no warning signs before liver failure strikes. Victims often mistake early symptoms for the flu and take more Tylenol, sealing their fate. The antidote only works within eight hours, but accidental poisoning victims rarely realize they're in danger until it's too late.
Key insight: Despite these risks, the FDA requires stronger warnings on prescription acetaminophen (325mg) than over-the-counter Extra Strength Tylenol (500mg).
Section: 3, Chapter: 13
From Miracle To Poison In The Blood
EPO was hailed as one of the most important biotech breakthroughs—a synthetic protein that stimulates red blood cell production. For dialysis patients losing blood, it seemed like a miracle. Fortune named it Product of the Year in 1989.
But early warning signs emerged quickly. Cyclists died suddenly after using EPO. Cancer researchers found that adding EPO to tumor cells supercharged their growth. Yet J&J pushed EPO to cancer patients anyway, promising to conduct safety studies that never materialized—or whose devastating results were hidden for decades.
Section: 4, Chapter: 15
How Giving Cash To Doctors Became Good Business
The transformation of medicine began when IMS Health (co-founded by Purdue's Arthur Sackler) created a database tracking every prescription written by every doctor in America. Suddenly, companies could measure the exact return on their 'investments' in physicians.
The ROI was extraordinary: Every dollar given to doctors generated $3.50 to $5.00 in additional drug sales. This return dwarfed any other corporate investment, leading companies to rebuild around sales operations that funneled money to doctors through:
- Consulting agreements and speaking fees
- 'Dine-and-dashes' at expensive restaurants
- Golf outings and concert tickets
- Free office meals and drug samples
Section: 4, Chapter: 16
They Made It All Up
'When I started speaking for companies in the late 1980s and early '90s, I was allowed to say what I thought I should say consistent with the science. Then it got to the point where I was no longer allowed to do that. I was given slides and told, 'We'll give you a thousand dollars if you say this for a half hour.' And I said: 'I can't say that. It isn't true.' They made it all up. It was never true.'
- Dr. Stefan Kruszewski (Harvard-educated psychiatrist and former J&J speaker)
Section: 4, Chapter: 16
J&J's Biggest-Selling Drug Built On Hidden Bodies
By 1998, Procrit had become J&J's most profitable product ever, representing over 10% of total company sales. Oncologists enthusiastically prescribed the drug, assuming its benefits outweighed risks because J&J claimed it was still enrolling patients in safety studies.
The truth was darker: J&J had been secretly discovering that EPO killed cancer patients in study after study. When Michael Henke bravely published results showing EPO increased cancer progression by 69% and death by 39%, it shattered the illusion. Paul Goldberg then revealed that multiple other studies—all hidden by J&J and Amgen—had found the same lethal pattern.
Section: 4, Chapter: 17
The Researcher Who Refused To Play Along
Michael Henke was supposed to be another compliant researcher. When his EPO study found the drug was killing cancer patients, industry pressure mounted to bury the results like so many others before. His sponsor company was making hundreds of millions from EPO sales.
But Henke broke the pattern. Despite personal and professional pressure, he published his devastating findings: EPO use resulted in 69% more cancer progression and 39% more deaths. His refusal to cover up the truth finally exposed what J&J and Amgen had known for years—that EPO was 'Miracle-Gro for cancer.'
Section: 4, Chapter: 18
Every Drug Has Risks
'Every drug has risks. That phrase was repeated countless times in my interviews with those involved in J&J's myriad drug disasters. This is an undeniable fact, known by everyone who works in healthcare. The real danger, though, comes when profit is the corresponding benefit.'
- Gardiner Harris
Section: 4, Chapter: 18
Honesty Is A Very Broad Term
During cross-examination about Risperdal, Dr. Gahan Pandina—J&J's senior scientist for the drug—was asked a simple question: 'Drug companies should be honest with the public, right?'
His response revealed the company's moral bankruptcy: 'Honesty is a very broad term. I would say they should abide by the regulations and rules.'
When pressed again with the same basic question about honesty, he repeated: 'Again, honesty is a very broad term.' This exchange, captured in court, demonstrated how completely J&J executives had abandoned basic moral principles in favor of regulatory gamesmanship.
Section: 4, Chapter: 19
Miracle-Gro For Cancer
Dr. Otis Brawley of the American Cancer Society captured the EPO scandal in one devastating question: 'What data do you have to assure me that this is not Miracle-Gro for cancer?'
Eight large studies would eventually prove EPO increased cancer growth and death rates. J&J's own twenty-three-year study finally published in 2016 showed women getting EPO were:
- Twice as likely to suffer strokes and blood clots
- More likely to die
- Had tumors that grew significantly bigger and faster after twelve months
Yet doctors continued prescribing EPO because the financial incentives were too attractive to resist.
Section: 4, Chapter: 19
The Army Ranger's Philosophy
'No matter what obstacle you face, you are going to find a way to get over it, through it, around it, under it.'
- Alex Gorsky (describing lesson learned at Army Ranger School)
Section: 5, Chapter: 20
The Army Officer Who Led The Marketing Wars
Alex Gorsky's path from West Point to CEO embodied American ambition. The son of immigrants, he learned at Army Ranger School that 'no matter what obstacle you face, you are going to find a way to get over it, through it, around it, under it.' This mindset would define his corporate career.
Gorsky transformed J&J's sales approach, pioneering the illegal marketing tactics that generated billions while causing massive harm. His promotion to CEO came while federal prosecutors called him 'actively involved' in fraudulent matters. He would oversee criminal marketing for six of J&J's seven top-selling drugs in 2003.
Section: 5, Chapter: 20
The Path To A Normal Life Becomes A Nightmare
Risperdal was supposed to be a breakthrough—an antipsychotic that treated schizophrenia without the devastating tics and tremors of older drugs. The FDA approved it in 1993 for this narrow use. But Alex Gorsky faced impossible sales targets that couldn't be met by treating only schizophrenics.
J&J's solution was to illegally expand the market. They created 'Sell to the Symptoms'—a strategy claiming Risperdal treated virtually any emotional state listed on psychiatric rating scales. The acronym DART (depression, agitation, racing thoughts) became their weapon to push the drug far beyond its approved use, targeting children and the elderly despite knowing the devastating consequences.
Section: 5, Chapter: 20
Sell The Symptoms Strategy
J&J pioneered an illegal marketing strategy that became the industry template: 'Sell to the Symptoms, Not Diagnosis.' Sales reps would ask doctors if they had patients with anxiety, hostility, or agitation, then claim Risperdal treated these symptoms.
The strategy exploited a psychiatric rating scale (PANSS) that included most human emotions—from tension to grandiosity to poor impulse control. Since sales reps couldn't recite all symptoms, J&J created tailored lists: one for doctors treating elderly patients, another for pediatricians. This allowed them to market a schizophrenia drug for virtually any behavioral issue while maintaining plausible deniability.
Section: 5, Chapter: 21
When Hospitals Become Factories Of Death
Memorial Sloan Kettering researchers found that between 2000-2019, antipsychotic medicines like Risperdal caused 1.2 million needless deaths among the elderly—killing 20,000-65,000 patients annually. By comparison, prescription opioids caused about 16,000 deaths in 2020.
These drugs are still routinely used in nursing homes as 'chemical restraints' to compensate for inadequate staffing. The 1987 law meant to prevent this abuse was co-opted by J&J and Omnicare to switch patients to more expensive antipsychotics. 75% of nursing homes fail to meet minimal staffing requirements, making dangerous drugging seem like the only option.
Section: 5, Chapter: 22
Big Targets And Small Victims
Children with behavioral problems represented an $821 million annual opportunity for Risperdal sales. J&J sponsored clinical trials knowing the drug would cause severe weight gain, fatigue, and permanent damage to developing endocrine systems.
Children gained 4-6 pounds monthly on Risperdal—weight that proved nearly impossible to lose. The emotional devastation was profound: kids became grossly obese and socially isolated. For boys, the drug caused permanent breast development requiring double mastectomies. J&J's internal studies showed gynecomastia rates as high as 13%, but the company buried this data for years while thousands more children were harmed.
Section: 5, Chapter: 23
Ice Cream Parties And Permanent Damage
To push Risperdal to children, J&J sales reps held 'ice cream and popcorn parties' in child psychiatrists' offices, handing out lollipops and Risperdal-branded Lego toys. The marketing worked—but came with a horrific cost.
J&J's own study showed that 13% of boys developed permanent breasts (gynecomastia). The company buried these results for years, using statistical tricks and excluding data from publications. When the truth emerged, thousands of boys had been permanently disfigured. One mother described her son's confusion: 'He just doesn't have the capacity to ask me why [he looks like me up there].'
Section: 5, Chapter: 24
The Whistleblower's Breaking Point
Vicki Starr joined J&J believing it was the most ethical pharmaceutical company. As a former Lilly sales rep and pharmacist, she was proud to work for the healthcare giant. But the company's 'Sell to the Symptoms' training felt wrong—like promoting antipsychotics for almost any emotional state.
The final straw came when psychiatrists told her too many boys were growing breasts from Risperdal, but J&J executives denied the problem entirely. 'They were like used car salesmen,' she said. Starr became the first Risperdal whistleblower, ultimately wearing a wire to record J&J's illegal marketing presentations.
Section: 5, Chapter: 25
Death Warning Doesn't Stop The Sales Machine
In April 2005, the FDA mandated that Risperdal carry a black box warning—the strongest possible—stating that elderly patients with dementia faced increased risk of death. The warning explicitly said Risperdal was not approved for dementia.
J&J's response was to expand illegal sales efforts, not stop them. They gave sales reps two new messages: tell doctors they couldn't be sued because proving causation was 'practically impossible,' and instruct them to diagnose dementia patients with schizophrenia to hide what they were doing. Risperdal sales grew 18% that year despite the death warning.
Section: 5, Chapter: 26
An Epidemic Foretold
Five years before OxyContin launched, the FDA's Curtis Wright foresaw everything that would go wrong with Johnson & Johnson's fentanyl patch, Duragesic. He warned about extraction potential, need for special precautions, and overdose risks.
Despite his warnings, Wright approved Duragesic anyway. Deaths began immediately—a seventeen-year-old Florida boy died in his sleep after following doctor's orders exactly. When his mother complained to the FDA about fifty-two similar deaths, Commissioner David Kessler demanded action. But Wright, who later took a $400,000 job with Purdue, had already laid groundwork for the coming opioid epidemic.
Section: 6, Chapter: 28
Norman Poppies And The Opioid Supply Chain
J&J didn't just market opioids—they controlled the global supply chain that made the epidemic possible. In Tasmania, the company engineered 'Norman,' a mutant poppy that produced almost pure thebaine, the key ingredient for OxyContin.
Without J&J's agricultural innovations, former FDA Commissioner David Kessler testified, 'the United States would not have experienced the explosion in opioid prescriptions that it did.' The company supplied 65% of America's oxycodone while simultaneously copying Purdue's deadly marketing tactics—proving their role went far beyond any single product.
Section: 6, Chapter: 29
Engineering Super Poppies For America's Epidemic
In Tasmania's isolated fields, J&J created a botanical weapon for America's opioid crisis. After screening thousands of poppy seedlings, they engineered 'Norman'—a mutant poppy with a recessive gene that produced almost pure thebaine, the key ingredient for OxyContin.
Norman poppies yielded eight times more opioids per acre than Turkish varieties. J&J supplied 65% of America's oxycodone, 54% of hydrocodone, and 60% of morphine and codeine. As one accountant joked, they could give each farmer a 747 jet and still profit from the increased poppy acreage. Without J&J's innovation, the opioid epidemic couldn't have reached its devastating scale.
Section: 6, Chapter: 29
The Birth Control Patch That Tripled Stroke Risk
Ortho Evra was supposed to solve the birth control pill's main problem—women forgetting daily doses. But J&J's own testing revealed the patch delivered three times more estrogen than low-dose pills, dramatically increasing stroke and heart attack risks.
Instead of disclosing this to the FDA, J&J applied a 'correction factor' reducing the reported estrogen levels by 40%. The company mentioned this statistical manipulation only once in 435 pages, buried within a complex formula. The FDA never noticed the deception. Young women like eighteen-year-old Zakiya Kennedy and twenty-five-year-old Stephanie Rosfeld died as a result.
Section: 7, Chapter: 32
Hip Implants Designed To Fail
When J&J's engineer discovered their new hip implant was falling apart in testing just one day before FDA submission, executives faced a choice: admit the problem and redesign, or lie to regulators and launch anyway. They chose deception.
The Pinnacle metal-on-metal implant was nearly identical to devices that had failed catastrophically in the 1960s, crippling patients with metal poisoning. J&J's own PIN study—conducted without patient consent or ethics approval—showed devastating failure rates. But the company published false claims of 99.9% success while patients suffered bone death, heart attacks, and blindness from metal toxicity.
Section: 8, Chapter: 34
God, Nazis, And Medical Research Ethics
J&J's PIN study for Pinnacle hip implants violated virtually every ethical rule governing human research. The company referenced both the Ten Commandments and Nazi medical atrocities when training staff on research ethics—then systematically violated those standards.
806 patients were enrolled without proper consent or ethics approval. When institutional review boards learned about the study, responses were scathing. Mayo Clinic's ethics committee voted 12-0 against approval, stating there was 'not a sound scientific basis' and the sponsor's main aim was 'to foster use of the implant.' The study was pure marketing disguised as research.
Section: 8, Chapter: 35
A Cure For Sag Becomes A Nightmare
Millions of women face pelvic organ prolapse—internal sagging that causes incontinence and discomfort. J&J's Prolift mesh promised a simple cure: plastic mesh inserted through the vagina to hold organs in place.
But J&J knew from the start it didn't work. The French inventors warned that mesh was protruding through vaginal walls in too many patients and recommended returning to 'the concept stage.' Italian surgeons reported sex was 'like screwing a wire brush.' Yet J&J launched anyway without FDA approval, causing hundreds of thousands of women permanent injury and destroying their intimate relationships.
Section: 9, Chapter: 37
The Social Normalization Of Corporate Deviance
Columbia sociologist Diane Vaughan's analysis of the Challenger disaster explains J&J's transformation. 'Social normalization of deviance' means people inside organizations become accustomed to dangerous behavior that outsiders would recognize as insane.
J&J's decline followed this pattern: small compromises on Baby Powder safety in the 1960s led to document destruction in the 1980s, then systematic lying in the 1990s, and finally launching products known to be deadly in the 2000s. Each step seemed rational to insiders who had lost all perspective. The credo became corporate gaslighting while executives abandoned basic decency.
Section: 10, Chapter: 39
The Failed Covid Savior
Covid offered J&J a rare shot at redemption—a chance to save the world and restore its tarnished reputation. CEO Alex Gorsky appeared at the White House with President Biden, promising single-dose convenience and global distribution.
But J&J's vaccine became another disaster: contamination at manufacturing partner Emergent destroyed 15 million doses. The FDA paused distribution due to dangerous blood clots. Effectiveness was only 65% compared to Pfizer and Moderna's 95%. Against Omicron, it was nearly useless. The FDA quietly revoked authorization in 2023. J&J's attempt at redemption became a punchline.
Section: 10, Chapter: 39
If Johnson & Johnson Had Never Existed
Would the world be better without J&J? The company created vital medical innovations: surgical sutures used globally, HIV treatments for adolescents, the first tuberculosis drug in forty years, and disposable contact lenses. Its early commitment to sterilization saved countless lives.
But J&J also contributed to millions of deaths through criminal marketing of dangerous drugs. It poisoned babies with asbestos, crippled patients with metal implants, and fueled the opioid crisis. The company was essentially a criminal enterprise that targeted society's most vulnerable—children, the elderly, and the desperately ill. Its true legacy isn't innovation but the normalization of corporate sociopathy.
Section: 10, Chapter: 39