Johnson & Johnson’s dark history in India and the United States

IT IS A MARKETING STORY for the ages. In 1918, the American pharmaceutical giant Johnson & Johnson (J & J) launched the largest advertising campaign in its history to promote its baby powder. The campaign was so successful that, more than a century later, the J & J brand still instantly evokes images of infant care and remains widely trusted..At least since the 1970s, however, the company knew that the talc used in its baby powder was contaminated with trace amounts of asbestos, a known carcinogen. Yet the product was only pulled from the shelves in the United States and Canada in 2020, and across the world in 2023..A similar pattern of concealing critical information extended to several other drugs and medical implants the company produced. The number of patients who have died over the years as a direct result is estimated to exceed two million. What makes J & J’s story so complicated is that, amid this, many of its products are truly lifesaving, including medicines for HIV, cancer and rheumatoid arthritis..In The Dark Secrets of Johnson & Johnson, the New York Times pharma reporter Gardiner Harris provides a sweeping account of the company’s origins and global impact since the late 1800s, told primarily from an US-centric perspective. Another recent book that scrutinises the company’s operations and impact is The Johnson & Johnson Files: The Indian Secrets of a Global Giant, by the Indian Express journalist Kaunain Sheriff M. This focuses on J & J’s faulty hip implants in India, documenting heartbreaking testimony from patients whose lives were upended by them..Both authors arrive at the same conclusion: over the years, J & J leveraged its financial clout – particularly its vast advertising budget – to evade accountability and cultivate an image entirely divorced from reality. The company misled regulators, journalists and patients, distorted evidence and repeatedly placed profits above patient safety..A CHANCE CONVERSATION with an unnamed pharmaceutical representative at Chicago’s O’Hare International Airport in 2004 prompted Harris to take a closer look at the company long known for its polished public image. He traces how J & J exploited regulatory gaps within the United States Food and Drug Administration (FDA) to keep its products on the market and shielded from controversy. The company also pressured scientists to suppress research raising concerns about its products, offering freebies as inducements and, when those failed, launching smear campaigns to discredit them..Harris details how J & J downplayed repeated contamination of its widely used drug Tylenol; concealed deadly side effects of erythropoietin and the anti-psychotic Risperdal; contributed significantly to the opioid crisis in the United States; and knowingly sold faulty hip and vaginal mesh implants..The media, too, has been an instrument of corporate control. J & J leveraged its massive advertising budget to dissuade news outlets from publishing negative coverage. Harris shows how a pharmaceutical company of J & J’s size and resources can manipulate even reputable journalists – sowing confusion or, in some cases, issuing threats. For nearly half a century, the company has engaged with the press strictly on its own terms, restricting access while sponsoring events and awards..Another key theme Harris explores is intentionality. Much of the harm J & J caused could have been prevented had the company acted on the evidence it already possessed and been transparent. Instead, it resisted phasing out asbestos-laced talc powders, including its iconic baby powder and its “Shower to Shower” brand body powders, even as other companies began replacing talc with safer alternatives like cornstarch as early as in the 1980s..Women were often exposed to J & J talcum powders while applying them to infants, or using it on themselves to mask underarm sweat or prevent chafing on the thighs. Over time, evidence mounted linking asbestos exposure to higher rates of ovarian cancer. Harris cites a 1982 study showing that women who applied talc to the genital area faced a 92-percent higher risk of ovarian cancer..It took nearly four decades of advocacy by researchers, cancer experts, civil society groups and affected patients to force the company to pull its talcum powders from the US market. This step came in 2020, following a major court loss and mounting national criticism. J & J did not withdraw the product from global markets until a full three years later. Harris neither examines nor acknowledges this delay..Harris focuses primarily on how J & J was held to account within the United States, where at least some checks and balances existed. What he overlooks, however, is that while J & J may be a quintessential American company, it operates in dozens of countries and sells its products nearly worldwide. The harms he documents, therefore, represent only a fraction of those inflicted globally..J & J has also had public-relations wins. A notable example is Tylenol, a commonly used fever and pain reliever, which in 1982 was linked to several deaths in Chicago due to cyanide contamination. In this case, the contamination was traced to a third party, not the company itself. The company swiftly recalled every capsule from the market, at a cost of USD 100 million, and introduced safer packaging within months. The FDA subsequently pushed other companies to adopt similarly rigorous packaging standards to prevent similar future incidents..What J & J did not disclose publicly was that, years before the Tylenol-linked deaths made headlines, it was aware of other similar fatalities and took no action. This meant that when the issue finally drew media attention, the company – already months into preparing new packaging – was able to act swiftly and bolster its public credibility. The FDA also permitted J & J to continue selling Tylenol without a warning label about the increased risk of acute liver failure that came with it, leaving patients uninformed..More than one J & J drug has been linked to increased patient deaths. One example is erythropoietin (EPO) – a drug marketed to cancer patients to boost the production of red blood cells during chemotherapy, and misused by elite athletes to enhance performance. Early independent research and patient reports suggested the drug could worsen heart health and, in cancer patients, promote tumour growth..We’re on a mission to give Southasia literature the spotlight it deserves. Become a paying Himal Patron for just USD 5 / month to support the Southasia Review of Books!.Harris notes that J & J knew the drug was harming patients for nearly two decades. On page after page, referring to clinical trial results and internal investigations, he emphasises that “J & J kept whatever evidence it had secret.” While some lapses may be inevitable in a company of J & J’s size, what stands out is the deliberate continuation of practices that put patient health at risk until strong legal or media pressure forced action..Harris’s strength lies, in a way, in his refusal to pass judgment amid a rigorous reporting of the facts. Some pertain specifically to J & J, while others – such as the use of freebies for doctors to influence prescriptions, or the deployment of persuasive sales representatives to keep problematic drugs in the market – reflect strategies widely used across the pharmaceutical industry..Over the decades, most pharmaceutical companies have realised that the fastest way to reach patients is through their doctors, and J & J is no exception. Beyond the familiar tactic of offering cash and gifts to medical practitioners in return for prescribing J & J products, the company enlisted pliable academics to write favourable articles about its drugs and got them published them in lesser-known journals with minimal oversight. Many physicians, misled by the veneer of credibility, mistook these articles for unbiased, peer-reviewed evidence..(Harris also highlights the work of researchers like Dr Michael Henke, whose 2003 study in The Lancet finally broke the silence around the potentially fatal risks of EPO.).Harris’s account makes clear that J & J could not have caused harm on this scale without the complicity of the wider US healthcare system. Sales representatives pushed drugs and implants they knew were risky, doctors recommended them to unsuspecting patients, and officials within the FDA looked the other way more than once..What emerges repeatedly is that the pharmaceutical giant treats patients as “customers”. That its products form a significant part of the bedrock of the global healthcare sector is incidental for the company. Its approach to basic safety standards resembles that of any other profit-driven corporation rather than of one entrusted with safeguarding human life and taking that responsibility seriously. The duty of care one would normally associate with and expect from a healthcare manufacturer is largely absent. .J & J’S STORY turns particularly grim when Harris describes the company’s push to market the anti-psychotic drug Risperdal to children and the elderly – cohorts it identified as potentially lucrative user groups. He recounts harrowing stories: young boys who developed breasts and elderly patients who died in significant numbers. All the while, the company had evidence to indicate that these outcomes were likely, yet it concealed the data from the public and from healthcare professionals, much as it did in marketing EPO to cancer patients. The book remains especially relevant because many of the drugs it looks at are still on the market, and continue to rake in substantial sales..J & J’s conduct has contributed to eroding public faith in the healthcare industry, and it is easy to see how this erosion fed into behaviours like vaccine hesitancy during the Covid-19 pandemic. Patients have been misled and gaslit for generations, leaving them wary not only of pharmaceutical companies but also of government and regulatory officials who have repeatedly been shown to be complicit in malpractice. .Harris also makes it clear that J & J is not an outlier. Other pharmaceutical giants – including Eli Lilly, AstraZeneca, Pfizer and Bristol Myers Squibb – have engaged in similar practices, from making false claims to concealing clinical trial data to keep dangerous or substandard drugs on the market..He reserves particular scrutiny for the especially sinister role J & J played in the US opioid crisis, which caused more than 100,000 deaths in 2023 alone according to official figures. The present epidemic of opioid use disorder was fuelled by companies aggressively marketing opioids as pain relievers despite knowing they were highly addictive. While Purdue Pharma, the maker of OxyContin, has absorbed most of the resulting public outrage, Harris shows that J & J’s involvement in the crisis ran even deeper than this maligned company’s. Its opioid entered the market earlier and remained there despite clear evidence of the harm it was causing..Pills, Perils, Profits: A Himal investigative series on Southasian pharma.In 1990, J & J introduced Duragesic – a fentanyl patch that claimed to deliver a steady dose of an opioid pain reliever over 72 hours. The company knew it was both addictive and dangerous: among other issues, the patch was unreliable, sometimes releasing higher doses in a shorter period and so leading to overdoses and deaths..Purdue’s OxyContin entered the market in 1995, followed by several other opioid products over the next decade. Many patients were introduced to these drugs via prescription after surgeries or injuries such as fractures, only to find themselves addicted..Harris returns repeatedly to the fact that J & J is complicit in many deaths. In some cases, such as with the baby powder, it took many years for evidence of harm to surface and for the company to understand the risks its products carried. But, in numerous instances, and especially in more recent years, the company failed to act to protect patients with full knowledge of the harms it was causing. Early on after launching its hip implants, knee implants and vaginal mesh implants, J & J knew that these were causing acute distress to patients who were already ill and had placed their trust in the company. .A larger issue Harris spotlights is that of evidence: who generates it, and who funds this generation. The FDA is often seen as relying for its regulatory decisions on clinical trial data produced by pharmaceutical companies on their own products. In recent years, conflicts of interest in clinical trials have rightly drawn scrutiny, and Harris lays bare the consequences that can follow when evidence is tampered with or selectively presented. .The massive failures of India’s drug regulatory system.While Harris attempts to offer a window into the inner workings of J & J, he also lays bare the repeated failures of the FDA. He details the agency’s resource constraints, internal politics, periodic incompetence and, most crucially, its consistent reluctance to hold pharmaceutical giants like J & J to account..SEEN FROM THE PERSPECTIVE of developing countries, all of this is especially alarming. FDA approval in the United States often leads other countries – many without the resources to conduct independent testing or clinical research – to deem a drug safe in their own jurisdictions. As a result, when the FDA fails US patients, it also endangers millions elsewhere..Sheriff documents part of this wider global impact in painstaking detail. His investigation began with an email in August 2018 from the Pune-based Lata Pillay. Her husband, Dinesh Pillay, had been fitted with a J & J hip implant in 2007, which left him in such debilitating pain that he could not walk long distances or work. The implant had a critical design flaw that caused it to wear out far earlier than intended and leach toxic cobalt and chromium metal ions into patients’ bodies. Sheriff tracked down other patients and their legal battles against the company in India, following their cases through to 2024. .A central takeaway from his reporting is that while J & J’s hip implants caused immense harm worldwide, the company treated Indian lives as less valuable than those in richer countries, with the company exploiting weaker regulatory systems across the Global South. He also suggests that, much like with the FDA in the United States, some officials in India’s state-level regulatory bodies may have been complicit, putting corporate interests ahead of patient welfare..J & J has long enjoyed a stellar reputation in India. A newborn in an Indian family is often greeted with a J & J gift hamper – soap, shampoo and talcum powder included. So when the company introduced its new hip implants in the country in 2004, they were met with excitement rather than scrutiny. The product arrived at a time when India’s private healthcare sector had become one of the world’s twenty largest, attracting a surge of medical tourists drawn by comparatively affordable treatment costs..Yet oversight of this booming market was minimal. State-level drug regulators across India had neither the capacity nor the mandate to conduct meaningful drug testing or large-scale trials. The Medical Council of India (MCI) had guidelines that were rarely enforced, and the cosy relationship between doctors and pharmaceutical companies had yet to face serious media or regulatory scrutiny..Sheriff investigates how J & J’s articular surface replacement (ASR) hip implants caused physical, psychological and financial trauma for patients in India. His reporting blends extensive on-the-ground interviews with documentary evidence proving that the company delayed recalling the product from the Indian market long after it was withdrawn in the United States..India had become a hub for medical tourism, so many affected patients were not Indian citizens. Sheriff recounts the story of a patient he identifies only by her first name, Monica. The young woman from Park City in the United States flew to Chennai in 2008 to receive the implant, but it only led to worsening pain. After years of declining health, her doctors discovered dangerously high levels in her blood of cobalt and chromium leaching from the defective device. She underwent an expensive revision surgery in 2013, followed by a long and difficult recovery..Sheriff also shows how patients were kept in the dark – not just by their doctors but also by hospitals – even after it was evident that the implants were at fault for their complaints. Almost all the patient stories he documents come from the private sector, where large corporate hospitals were beginning to dominate just as the new implants arrived..Where Harris writes of two million deaths and millions more lives affected, Sheriff gives those numbers faces and contexts, entering homes and hospitals to show the lived consequences. The result is a harrowing account in which justice and accountability remain elusive..One story he presents is that of the 67-year-old Daisy Bharucha from Mumbai. She received a hip implant in 2007 and learnt during another surgery in 2008 that it had caused an infection. But it was only in 2011 that her family discovered her deteriorating health was due to metal ions the implant was releasing into her body. In 2013, she took DePuy, the J & J subsidiary that manufactured the implants, to consumer court. Bharucha died of cancer the following year, but her family pursued the case until 2024, ultimately receiving a settlement of INR 35 lakh, or roughly USD 40,000 – far too little, far too late..AS IN THE UNITED STATES, the failures in India unfolded at multiple levels. Regulators were ill-equipped, hospitals continued to promote J & J implants despite the presence of several safer alternatives, and some doctors withheld critical information from their patients..Corporate misinformation compounded the harm. Many doctors who recommended the implants initially believed they were of superior quality, until patients began returning with serious complications. When some surgeons raised concerns, company officials tried to discredit them – gaslighting echoed across countries. J & J representatives even suggested that the problem lay not in the implants but in surgeons’ “faulty” techniques, sowing confusion and delay. But as the number of patients reporting worsening pain grew, the evidence became impossible to dismiss..Sheriff highlights the work of Antoni Nargol, an orthopaedic surgeon then at the University Hospital of North Tees in the United Kingdom, who performed ASR implants both there and in India. Between 2004 and 2007, he conducted nearly 200 such surgeries. When his patients began reporting complications, he raised the issue with DePuy. Along with his team, he launched his own clinical study, published the findings and lobbied policymakers. His efforts were instrumental in forcing the global recall of J & J’s ASR implant..While Harris surveys a wide range of J & J products and their consequences, Sheriff focuses specifically on hip implants, allowing him to go deep into the lives of affected patients. The two books function as complementary parts of the same puzzle. Read together, they answer lingering questions and point to one unavoidable conclusion: the suffering was entirely preventable had the company acted with integrity..Sheriff exposes how there is minimal regulatory oversight in India for medical implants – not just hip implants, but also coronary stents and pacemakers. This vacuum has allowed pharmaceutical and device manufacturers to aggressively market products to hospitals and doctors with little scrutiny. Patients themselves almost never have a say in the choice of implant they receive, leaving them deeply vulnerable..His reporting shows that many care providers selected devices based on the kickbacks offered rather than their safety or efficacy. The result was patients put at serious risk while also being saddled with inflated medical bills, trapping them in a system they could neither question nor escape..Once the implants were in place, there were no regulatory mechanisms to test, monitor, or verify whether these devices performed as manufacturers claimed. Faulty products could remain in use for years without detection or accountability..The legal system further compounded the suffering. India had no established framework to calculate compensation for such cases, making litigation slow and uneven. J & J pre-empted potential court-imposed penalties by unilaterally announcing compensation amount of INR 25 lakh per patient. This helped the company limit its liability, even though it made no attempt to identify or reach out to affected patients..Harris argues that, beyond protecting profits, J & J delayed recalling faulty products because acknowledging fault would open the door to lawsuits. Sheriff shows that the eventual global recall of the ASR hip implants happened only because doctors, researchers and patients worked collectively to challenge the company. Even then, the recall took place quietly, with little transparency..When J & J announced a recall of its ASR hip implants in 2010, India had no framework for regulating or managing medical device recalls. Hospitals and health authorities were unprepared, and there was no protocol to notify, trace or support affected patients..Sheriff documents how several patients learnt their implants were failing not through their doctors or hospitals, but through media reports or their own research. Even today, some continue to live in pain, unaware that faulty J & J implants are the cause. More worryingly, he explains that even after the faulty implants are removed, tiny metal fragments left behind can continue to leach chromium and cobalt into the bloodstream. This slow poisoning severely reduces quality of life and leaves patients with long-term health complications..Drawing on his background in legal reporting, Sheriff traces how some bureaucrats and law-enforcement officials did attempt to hold J & J accountable as the company delayed paying compensation to thousands of affected people. He details how J & J not only stalled the process but actively obstructed it – refusing for years to share critical data that would have helped authorities locate patients..The book ends abruptly, in part because so few patients in India – roughly 4700 patients who were fitted with the implant – found justice. Bharucha’s case is one of the only ones to reach closure, and even that came after years of delay and yielded compensation that was far from adequate. The lack of resolution underscores not only J & J’s failures but also the failure of India’s legal system to hold the company accountable, even as other countries have done so. In Sheriff’s telling, there is no redemption for J & J.