Medical professionals would never lie
Instead of warning the public and switching from talc to cornstarch, the company declared what Harris calls a “scorched-earth public relations campaign” on troublesome science. It leaned on Mount Sinai’s board to discredit its own research; devised a novel method for measuring contamination that was designed to fail; and turned to a Mengelean in-house researcher named Dr. Albert M. Kligmanto conduct disturbing experiments that involved injecting talc and asbestos into the flesh of Black prisoners. Kligman’s reports to corporate confirmed the minerals caused extreme irritation when injected, but said nothing about cancer, because it was not a subject of study.
ears after the blockbuster’s over-the-counter release, research revealed the drug’s toxic effects on the liver. When the company applied for an “Extra Strength” version in 1975—upping the recommended dose by about a third, to 500 milligrams—The Lancetdeclared acetaminophen “one of the commonest causes” of liver failure in Britain, and editorialized that if it “were discovered today it would not be approved.” With Extra Strength’s approval by the Food and Drug Administration in 1976, the drug’s slim margin of error between recommended and dangerous doses all but disappeared. Documents show that Johnson & Johnson was aware of this, and knew that adding even small amounts to recommended doses on top of moderate drinking could cause “catastrophic liver damage.” Once again, it fought tooth and nail to protect the illusion of Tylenol’s safety, resisting even updated warning labels until 1994. Harris writes that this was especially baleful for pediatric versions of the product, including an infant formula. Between 2000 and 2009, the FDA estimates that at least 20 children died from overdoses. As with Baby Powder, this legacy persists in the (at least) 150 Americans who die and the 30,000 hospitalized every year from overdosing on acetaminophen. For many years, the company maintained that all acetaminophen-related adult deaths were intentional suicides.
To accomplish this, the company hired a national sales force—D1 cheerleaders and West Point grads were favored—and spent enormous sums systemically bribing the nation’s doctors and medical thought leaders. Like previous gambits, it was a spectacular success. “Every dollar given to doctors led to between $3.50 and $5 in additional drug sales,” writes Harris.
Johnson & Johnson targeted the much larger (and untested) cancer market by selling Procrit as a treatment for anemic chemotherapy patients. Wall Street thought the strategy inspired; Fortunenamed Procrit 1989’s “Product of the Year.”
There was just one problem. Independent researchers quickly discovered that the drug not only posed heart-attack risks, but also supercharged the growth of tumors. Some tumors, it turned out, even had Erythropoietin receptors. As the evidence solidified, the chief medical officer of the American Cancer Society dubbed the product “Miracle-Gro for tumors.” But rather than pull Procrit from the cancer market, the company dusted off its Baby Powder script and sought to bury and discredit the science linking Procrit to tumor growth. A company researcher later testified to overhearing one Johnson & Johnson employee tell another, “We have to kill this work.” That they did. Johnson & Johnson hired doctors, writes Harris,
As with Procrit, the company focused on persuading doctors to prescribe the heavy tranquilizer to as many people, and for as many conditions, as possible. Harris quotes a sales plan draft from early in the process in which one executive observes, since the schizophrenic market is limited, “Aggressive expansion of Risperdal use in other indications is therefore necessary.” Here we are properly introduced to one of the book’s recurring villains, Alex Gorsky, the sales rep turned division chief tasked with creating markets for Risperdal. The strategy he devised, at once immoral and illegal, centered on telling psychiatrists that, because the drug was approved for schizophrenics, it could be prescribed for any and all conditions associated with schizophrenia. Gorsky focused on two demographic extremes. He established an “ElderCare” sales force to hype the drug’s benefits for “aggressive” dementia patients—despite the company’s own trials showing the drug caused high blood pressure, strokes, and higher rates of death among elderly patients—and another focused on pediatric psychiatrists, who were given samples and pamphlets that touted Risperdal as a broad-spectrum treatment for bipolar disorder and any “aggressive behaviors that annoy others.”
Aside from the obvious harm caused by putting hyperactive children on heavy tranquilizers, Johnson & Johnson concealed the extent to which Risperdal impacted the endocrine system by raising prolactin levels in hormone-secreting glands. In other words, the drug caused young males to gain weight, grow breasts, and lactate. Before Johnson & Johnson’s marketing campaign, pediatric bipolar diagnoses were extremely rare; the disorder’s very existence was a subject of debate. But that was before one-third of the nation’s psychiatrists started working as part-time sales reps for drug companies. After the rollout of Risperdal, diagnoses surged, growing fortyfold between 1994 and 2003. The key figure in what Harris calls the company’s “sophisticated disinformation scheme” was Harvard University’s Joseph Biederman, who received millions to legitimize the notion that very young children could be diagnosed as bipolar and prescribed antipsychotics. He was worth every penny the company paid him. In 1997, Risperdal sales reached $600 million.
In 2000, an independent study showed 13 percent of children on the drug had grown permanent breasts, more than a hundred times the rate on the warning label. Harris estimates, conservatively, that “twelve thousand boys were disfigured in that year alone.” Three years later, Johnson & Johnson rolled out a “back to school” campaign around a new dissolving tab form of Risperdal, replete with sales reps throwing “ice cream and popcorn parties” at child psychiatry offices across the country. As part of the campaign, the company distributed a branded chart, called “DART: Depression, Agitation, and Racing Thoughts,” to lower the prescription threshold to include more moderate behavioral issues.
Instead of warning the public and switching from talc to cornstarch, the company declared what Harris calls a “scorched-earth public relations campaign” on troublesome science. It leaned on Mount Sinai’s board to discredit its own research; devised a novel method for measuring contamination that was designed to fail; and turned to a Mengelean in-house researcher named Dr. Albert M. Kligmanto conduct disturbing experiments that involved injecting talc and asbestos into the flesh of Black prisoners. Kligman’s reports to corporate confirmed the minerals caused extreme irritation when injected, but said nothing about cancer, because it was not a subject of study.
ears after the blockbuster’s over-the-counter release, research revealed the drug’s toxic effects on the liver. When the company applied for an “Extra Strength” version in 1975—upping the recommended dose by about a third, to 500 milligrams—The Lancetdeclared acetaminophen “one of the commonest causes” of liver failure in Britain, and editorialized that if it “were discovered today it would not be approved.” With Extra Strength’s approval by the Food and Drug Administration in 1976, the drug’s slim margin of error between recommended and dangerous doses all but disappeared. Documents show that Johnson & Johnson was aware of this, and knew that adding even small amounts to recommended doses on top of moderate drinking could cause “catastrophic liver damage.” Once again, it fought tooth and nail to protect the illusion of Tylenol’s safety, resisting even updated warning labels until 1994. Harris writes that this was especially baleful for pediatric versions of the product, including an infant formula. Between 2000 and 2009, the FDA estimates that at least 20 children died from overdoses. As with Baby Powder, this legacy persists in the (at least) 150 Americans who die and the 30,000 hospitalized every year from overdosing on acetaminophen. For many years, the company maintained that all acetaminophen-related adult deaths were intentional suicides.
To accomplish this, the company hired a national sales force—D1 cheerleaders and West Point grads were favored—and spent enormous sums systemically bribing the nation’s doctors and medical thought leaders. Like previous gambits, it was a spectacular success. “Every dollar given to doctors led to between $3.50 and $5 in additional drug sales,” writes Harris.
Johnson & Johnson targeted the much larger (and untested) cancer market by selling Procrit as a treatment for anemic chemotherapy patients. Wall Street thought the strategy inspired; Fortunenamed Procrit 1989’s “Product of the Year.”
There was just one problem. Independent researchers quickly discovered that the drug not only posed heart-attack risks, but also supercharged the growth of tumors. Some tumors, it turned out, even had Erythropoietin receptors. As the evidence solidified, the chief medical officer of the American Cancer Society dubbed the product “Miracle-Gro for tumors.” But rather than pull Procrit from the cancer market, the company dusted off its Baby Powder script and sought to bury and discredit the science linking Procrit to tumor growth. A company researcher later testified to overhearing one Johnson & Johnson employee tell another, “We have to kill this work.” That they did. Johnson & Johnson hired doctors, writes Harris,
A few years after launch, Procrit had made the company more money than any other drug in its history, accounting for 10 percent of its drug sales and its fattest margins. The company charged $1,000 per dose—of which oncologists pocketed nearly one-third. Harris estimates that oncologists participating in Johnson’s deadly fraud doubled their salaries, on average, from $300,000 to $600,000. The company could not claim ignorance. It was later revealed that Johnson & Johnson shut down several in-house studies to test hemoglobin levels because cancer patients who got the drug showed accelerated tumor growth and died at much higher rates than the placebo group. Harris mentions one epidemiologist who estimates Procrit’s death toll in the hundreds of thousands and counting.
As with Procrit, the company focused on persuading doctors to prescribe the heavy tranquilizer to as many people, and for as many conditions, as possible. Harris quotes a sales plan draft from early in the process in which one executive observes, since the schizophrenic market is limited, “Aggressive expansion of Risperdal use in other indications is therefore necessary.” Here we are properly introduced to one of the book’s recurring villains, Alex Gorsky, the sales rep turned division chief tasked with creating markets for Risperdal. The strategy he devised, at once immoral and illegal, centered on telling psychiatrists that, because the drug was approved for schizophrenics, it could be prescribed for any and all conditions associated with schizophrenia. Gorsky focused on two demographic extremes. He established an “ElderCare” sales force to hype the drug’s benefits for “aggressive” dementia patients—despite the company’s own trials showing the drug caused high blood pressure, strokes, and higher rates of death among elderly patients—and another focused on pediatric psychiatrists, who were given samples and pamphlets that touted Risperdal as a broad-spectrum treatment for bipolar disorder and any “aggressive behaviors that annoy others.”
Aside from the obvious harm caused by putting hyperactive children on heavy tranquilizers, Johnson & Johnson concealed the extent to which Risperdal impacted the endocrine system by raising prolactin levels in hormone-secreting glands. In other words, the drug caused young males to gain weight, grow breasts, and lactate. Before Johnson & Johnson’s marketing campaign, pediatric bipolar diagnoses were extremely rare; the disorder’s very existence was a subject of debate. But that was before one-third of the nation’s psychiatrists started working as part-time sales reps for drug companies. After the rollout of Risperdal, diagnoses surged, growing fortyfold between 1994 and 2003. The key figure in what Harris calls the company’s “sophisticated disinformation scheme” was Harvard University’s Joseph Biederman, who received millions to legitimize the notion that very young children could be diagnosed as bipolar and prescribed antipsychotics. He was worth every penny the company paid him. In 1997, Risperdal sales reached $600 million.
In 2000, an independent study showed 13 percent of children on the drug had grown permanent breasts, more than a hundred times the rate on the warning label. Harris estimates, conservatively, that “twelve thousand boys were disfigured in that year alone.” Three years later, Johnson & Johnson rolled out a “back to school” campaign around a new dissolving tab form of Risperdal, replete with sales reps throwing “ice cream and popcorn parties” at child psychiatry offices across the country. As part of the campaign, the company distributed a branded chart, called “DART: Depression, Agitation, and Racing Thoughts,” to lower the prescription threshold to include more moderate behavioral issues.
A Devastating New Exposé of Johnson & Johnson Indicts an Entire System
An investigative history of the scandal-plagued company shines a light on a health care industry riddled with corruption and criminality.
newrepublic.com
