WHAT DO BABIES SMELL LIKE? The correct answer is Johnson & Johnson. The company put a lot of money into creating its signature scent—which consists of more than two hundred ingredients and is among the most recognized fragrances in the world—because of the well-established hold of smell on memory and memory on behavior. In more domestic-sphere terms we might call this hold, as some Johnson & Johnson employees did at an internal meeting in 2008, an “association of the Johnson’s name with both the mother-infant bond and mother’s touch as she uses the baby products.” If this feels a bit old-fashioned, it’s because the product has been around for more than 125 years. Call it good marketing. Call it the company’s “Golden Egg,” as Johnson & Johnson does. In No More Tears, a new book by investigative reporter Gardiner Harris, the author quotes J&J calling this association “one of the company’s most precious assets.” It starts, in No More Tears, with our most impressionable years.
It’s fitting that No More Tears makes its own first impression with a perfect book cover. Imagine the branding of Johnson’s assorted baby products averaged into one image. The circle-y pledge centered at the top of the baby powder label, which on the bottle asserts “clinically proven mildness,” here reads instead, “deception corruption death.” A bit dramatic, yes, and appropriate for a book whose subtitle promises “dark secrets.”
It all started for the author with a quintessentially American scene: a burger, a beer, and a stranger publicly shouting at a TV screen. In 2004, Harris walked into a “burger joint” at the airport and noted a woman watching a midday basketball game. He sat near her at the bar. After the final buzzer sounded, they struck up the conversation that would guide his research interests for years and culminate in this book. Harris was then a drug reporter for The New York Times, and the woman was a pharmaceutical drug rep for Janssen, a drug unit at Johnson & Johnson—what Harris calls in his introduction “a quintessentially American company.”
The drug rep had stories to tell. She hesitated then didn’t: her job had been to encourage doctors to prescribe Risperdal, an antipsychotic with wide-ranging side effects and a very narrow margin of efficacy, even to patients in whom she worried the drug’s harms might outweigh its benefits. Her nephew, then ten years old, had started taking the medication after it had been prescribed to him by a psychiatrist with whom she herself had helped arrange a consultation. The sample pills the doctor gave her nephew had been provided by the drug rep herself. The drug rep recommended her sister “‘think a minute before giving him that medicine.’” She knew better than anyone what it might do. At that point, J&J was still denying the link between Risperdal and metabolic syndrome, which includes insulin resistance. Risperdal wasn’t approved for use in children, “but it hadn’t not been approved, so . . .” she marketed it to doctors who would prescribe it. Her sister watched her son gain weight; her brother-in-law stopped speaking with her. The drug rep was, when she and Harris spoke, about to quit.
Among the first products the precursor to J&J—called Seabury & Johnson, after its founders—would create was a medicinal plaster, developed around the time of the American Civil War. The men took their product to the first official World’s Fair held in the United States. There, Harris tells us, they met doctors exhibiting antiseptic products they had used to dress surgical wounds. Johnson “took careful notes.” Seabury and Johnson soon decided to add rubber to their plasters, and their wound care dressings were doing really well, largely because of the ingenuity of Johnson’s younger brothers, whom he had brought on to help. Seabury split from the brothers because of drama I won’t get into, and J&J was born. The brothers got into the business of cotton and gauze bandages, and sales ballooned.
“World’s Fair,” “rubber,” “cotton.” All words that should ring alarm bells. In some ways, they tell you everything you need to know about where J&J was headed, which is exactly where it had started. No More Tears doesn’t get into, say, where the rubber might have come from, or explain to the reader what else was going on at the World’s Fair. For its purposes, surgeons were advancing medicine. I was trying to look into J&J’s early labor practices—since the company came together after the end of the Civil War—and found a poster advertised at an online auction site as “Good Times on the Old Plantation.” It includes a caption that reads, “Red Cross Cotton From Start to Finish.” Flanking the caption on either side are depictions of the old packaging of J&J’s early wound care. A roll of white gauze bearing a red cross unspools across the sky, like a shooting star, its edge blending into the clouds. I did not know, before reading No More Tears, that J&J shares license to the red cross icon with, well, the Red Cross, a deal it struck back in 1895. After the Red Cross licensed the symbol to for-profit companies selling first-aid equipment, J&J sued the Red Cross in 2007. Today, it’s the only company (besides the Red Cross) allowed to use the logo, one that carries a lot of moral cachet.
WHAT DO YOU THINK OF when you hear J&J? I think of baby products: baby shampoo, baby powder, baby oil. If I’m honest, before reading No More Tears I hadn’t begun to appreciate the extent of the company’s global reach. I vaguely knew that J&J, a conglomerate worth hundreds of billions of dollars, makes Tylenol and Band-Aids. I had no idea that it makes the Ethicon sutures many surgeons reach for intraoperatively. Or that its products list includes the synthetic blood cell production stimulator Procrit, or antipsychotics, or contraceptives, or orthopedic hardware. The list goes on. That we don’t associate these products under a single corporate umbrella is by design, a legal and marketing fail-safe. No More Tears gathers a representative sampling of these Johnson & Johnson’s products, organized into sections that read as case studies. Each product—or product type—offers an entry point into J&J as symptomatic of the American pharmaceutical industry. Each section traces troubling histories that map onto our current moment. By the end, a pattern emerges, clear as day.
The sections are: (1) Trust from Birth, which interrogates the endurance of J&J’s pristine reputation despite decades of evidence to the contrary. The next, the book’s most extensive, is (2) Johnson’s Baby Powder. Then, (3) Tylenol, (4) Procrit—a “miracle-gro for cancer”—(5) Risperdal, (6) Duragesic, (7) Ortho Evra Birth Control Patch, (8) Pinnacle Metal-on-Metal Hip Implant, (9) Prolift Vaginal Mesh, and, finally, (10) Covid. The COVID chapter, on the vaccine J&J eventually pulled from the market, has the punny title, “A Rare Shot at Redemption.” Very good.
No More Tears’s account of J&J’s corporate history is as damning as it is thorough, especially the section on baby powder. Early on, Harris tells us, J&J decided to add talc, a soft mineral, to its baby powder. The earliest reports documenting the harms of talc powder were published in 1922. Babies were asphyxiating, sometimes fatally, after inhaling too much powder during diaper changes, because talc’s molecular properties caused alveolar damage and obstruction. J&J put warning labels on its bottles, advising parents to “keep powder away from children’s nose and mouth.” The “deeper question,” however, and one that wasn’t asked right away, “was whether chronic inhalation of [talc powder] might be dangerous.” From here, we fork into a history of asbestos, and readers find themselves wondering, since the chapter is called “Johnson’s Baby Powder,” where we’re headed. Until it clicks: in 1968, a mineralogist investigating the high rates of asbestos in New Yorkers’ lungs in autopsies, noticed that “80 percent of the women were regular users of talcum powder.” He picked up some baby powders, including J&J’s, from a pharmacy, and took these to his lab, where he looked at them under a microscope. “All were contaminated with asbestos.” By the 1960s, a possible link between talc powder and cancer, including ovarian cancer, was established. J&J knew and spent the subsequent decades working to hide the evidence. At one point, given the health risks, the Food and Drug Administration (FDA) asked J&J to remove talc from the company’s baby powder, and J&J said no. J&J hired a dermatologist at UPenn named Albert Kligman, notorious for his experiments on incarcerated people and children—not to mention his racism—to inject Black prisoners (and rabbits) with asbestos and talc and report back what happened over the coming weeks (longitudinal studies weren’t conducted). The FDA investigated J&J then released a statement contradicting its own findings, endorsing the safety of a product the agency knew to be carcinogenic.
Many have heard of OxyContin and Purdue Pharma. Duragesic is J&J’s lesser-known fentanyl patch. As it concerns the opioid crisis, Harris makes a compelling case for why J&J is worse than Purdue. For one, J&J owns the poppy fields. The company also came up with the marketing scheme Purdue later copied. And J&J launched Duragesic only after the harms of opioids were well-established. Given this, Harris wonders why so much of the bad press fell on Purdue and away from J&J. Some of it has to do with the FDA.
Harris exposes how the FDA protected the industry it should be regulating. The FDA was founded in 1906. From that year until 1992, it was funded entirely by the US Treasury. In 1992, Congress passed the Prescription Drug User Fee Act (PDUFA), which allowed the FDA to collect fees from drug manufacturers, allegedly “to fund and speed up the process” of reviewing new drugs. In practice, this has left the FDA “financially dependent on the drug industry.” Today, nearly 75 percent of the agency’s drug division budget comes from pharmaceutical companies themselves. In 2011, J&J helped coordinate funding for the organization that saved thousands of jobs for the agency. It follows that the FDA is uniquely indebted.
Despite the breadth of Harris’s account, the conclusions drawn and next steps he proposes at the end feel a bit rushed, like an editor had asked for some actionable items right before the book was sent to print. Take the very last lines of the book,
That Johnson & Johnson has gotten away with so much is a devastating indictment of the country’s for-profit healthcare model at large. Maybe it’s time it, too, underwent a fundamental change. Perhaps there is a way in which we can band together and create this greater immunity.
My eyes met the word Acknowledgments where I was hoping for a final chapter. The story stops just as we start to get at the problem. Beyond this throwaway “for-profit healthcare model at large,” we don’t really get to see J&J as part of the web that is American health care, which would be the first step in grappling with what “fundamental change” might involve. One company at a time, others have taken on Purdue, someone else can investigate McKesson and Cardinal Health. And despite how clearly Harris establishes the role of the FDA in all of this, No More Tears doesn’t grapple with the possibility that this might not be the capture of an underfunded agency by a uniquely bad actor, so much as where a health care system built like ours in a country like this one, is destined to go. Sure, J&J’s criminality is exceptional, but it remains proportional to its power and reach.
Other countries don’t have a J&J—in part because J&J operates worldwide, dominating the market around the world. And in part because other countries’ regulating bodies are driven by interests that square more neatly with that basic medical oath, to do no harm. People need medicine, corporations need profit, and a system that wields the former in service of the latter is a setup for harm. This is self-evident enough that companies like J&J feel compelled to insist otherwise, almost to a soundtrack of nervous laughter. The J&J credo, drafted in 1943, reads, “We believe our first responsibility is to the patients, doctors and nurses, to mothers and fathers and all others who use our products and services. . . . Our business partners must have an opportunity to make a fair profit.”
It’s tempting to believe that the appeal of people like Secretary of Health and Human Services Robert Kennedy Jr. reflects some sticky mix of indiscernible stupidity and conspiratorial paranoia. It’s harder to consider that many Americans are naive enough to trust our current system. But then, what choice do they have? It’s scary to think that J&J is almost certainly the tip of the iceberg, and it is simpler to call the whole thing rotten than to try to discern—without a doctorate in chemistry, and without a stipend to commit your life to investigative work, and with only twenty-four hours in a day—what works and doesn’t.
What is happening where we have some direct control? Among the questions No More Tears doesn’t really engage—because it is dissecting a company—is how so many doctors and scientists continue to go along with what they must know is harming people. Harris notes that “it’s been the sales reps—not the executives or even the scientists—who have filed almost every whistleblower case against the industry. Many have a moral foundation that their more educated and better-paid supervisors and scientific colleagues seem to lack.” Level of education doesn’t correlate with morality or ethics. And many of the people who go through with medical and legal training get good at jumping through hoops, ends justifying means. They’ll follow the rules, however arbitrary, to get where they need to be. If the rules they’re following are good, they do good things. And if they’re not, often they’ll still comply. This is more surprising than it should be. As companies expanded the role of drug reps in marketing their products to doctors (the former often “funneling money” to the latter), they stopped hiring pharmacists and others with science degrees and started hiring cheerleaders; “equally prized were West Point graduates, who almost always followed orders without question and were admired by doctors and nurses alike.”
HARRIS HAS WORKED as a reporter for the Times for a long time, and this means there are certain connections he is inclined to make, and others to ignore. This isn’t an accusation of conscious self-censorship so much as an alignment in political sensibility, a sense of prioritization that places this American life at the very top, and other people’s lives somewhere else. The connections between the medical industry and the war machine are often ignored by even the most courageous investigative reporters, in part because it is a connection our minds aren’t taught to make, and so our eyes can’t see. It’s the first place I look, because it without fail explains everything else.
Among the countries in which J&J has invested is the start-up nation known as Israel, which should surprise exactly no one, least of all a diplomacy correspondent (Harris has in recent years pivoted from drug reporting). Israel has its own vast pharmaceutical industry, and rather than compete with it, J&J invests in the settler-colony’s biotech incubators, to advance its own medical technology. The separation between medical tech and military tech is thin, the tech itself shared where it can be. The company also invests in Israeli cancer immunology research, a venture saturated in almost as much irony as blood. Bombs cause cancer. Johnson & Johnson is investing in cancer research, in a country bombing cancer hospitals and blood banks to honor its commitment to permanently end the cellular repair mechanisms of Arabs—by killing them.
All of this is par for the course. Extension of life for some, promotion of death for others. The other thing I think of when I think of J&J, since at least 2019, is ovarian cancer. When, that year, my aunt, who had used J&J baby powder for decades as an ob-gyn practicing in Lebanon, heard about the association between talc and ovarian cancer, she reached out to an American group suing J&J. She had recently had a recurrence in her ovarian cancer; we had no family history of gynecologic cancer, and she had been diagnosed initially at a young enough age that environmental factors were reasonable to suspect as contributory. She was told by the legal team that because she had used the product in another country she was not eligible to join the suit for compensation.
We see this playing out today across all facets of life within and without the United States: some of us have the right to protest the self-evident dispensability of human life, others should lie down and die. Some people can rage at TV screens at the airport over missed layups, others can’t, and many of those others besides have other things to be angry about that consume their hours: the amputated limbs of children, people who are killed before they develop a drug’s worst side effects, people denied access to food and medicine and everything else a corporation can manufacture.
Harris is right: J&J’s products have touched billions of lives around the world. The company’s investments in Israeli firms have supported the building of surveillance tech and weapons that have killed hundreds of thousands of people, starved and maimed millions of others. On the firm’s site, J&J proudly declares that for periods of the 1960s, the company was the #1 supplier of medical supplies to the US military in Vietnam. And today, J&J remains committed to enabling the US military to “bring their unique experiences and strengths to the world.” Which is an incredible way to put what the US military does better than anyone else: kill people, often in the name of oil tanks they call liberty, freedom.
Hundreds of pages later, Harris feigns shock at what he uncovers this “quintessentially American company” has been up to. It’s part of every author’s bit, of course: perform the emotion they hope for the reader. No More Tears is a conclusive indictment of not just J&J but of the tangled industries that constitute our health care system. Harris’s exposé stops somewhere between J&J and America’s current borders, which is only abrupt if you already know more. A more encompassing frame, one that is exceptionally rare, would consider the rest of us, offer up J&J as an indictment of America’s tentacular imperial reach. Johnson & Johnson is, we agree, a quintessentially American company.
Mary Turfah is a writer and resident physician.