How did you start working on this book?

There were multiple moments in my life when I was shocked by Johnson & Johnson’s behaviour. I would do a story when I covered Johnson & Johnson and just sort of let it go, but it lived with me. I ended up as the South Asia correspondent, and then I came back and was a White House correspondent. Those are amazing jobs, but they are in many ways deeply unsatisfying, because you are a transcriber when you cover the White House and the State Department.

You simply tell people what you see, and oftentimes what you see is exactly what 50 of your colleagues are seeing. On the other hand, I knew there was this story about this dark and deadly giant that no one knew and that needed to be told as a means of offering some accountability for their victims and hopefully preventing them from continuing to exploit and take advantage of the millions of people that they have been exploiting and taking advantage of over many, many decades.

What is remarkable about Johnson & Johnson is how teflon its reputation is. Even though I did a series of one-off stories, each time I did them, people would say, well, the company made a mistake in this one instance, but it’s an incredible company. I decided that the only way to penetrate that shield was to do a book where I told the story of how they again and again sold products that not only didn’t help you, but actually hurt you, and lied to you about this.

What was the most surprising thing for you during the course of reporting for this book?

I grew up in Princeton, New Jersey, which is right near Johnson & Johnson’s headquarters in New Brunswick. Many of their top executives lived near me. I grew up with some of the kids. The assumption we all carried was that this company was the best company on the planet, and it just took a while to disabuse me of that. I think the Johnson & Johnson of the late 19th century and early 20th Century was truly one of the more ethical companies out there. They did the right thing.

Things started changing in the 1950s and 60s when they realised two things. One, that they have asbestos in their [baby] powder, and two, that asbestos is uniquely dangerous. Even microscopic amounts can injure and kill because they cause cancer of the lining of the lung called mesothelioma. As they begin to hide this problem and then try to persuade the FDA [Food and Drug Administration] that it is not a problem, and then begin a decades-long campaign of lying to the FDA about it, things start to change. With those early products, they launch a product, they think it’s okay, and they discover, soon after the launch, that things are not good and they suppress it.

But by the end of the book, with metal-on-metal hip implants and vaginal mesh, they knew well before they launched that they were going to injure and kill hundreds of thousands of people, before the first sale. Probably the most troubling part of the book was the Risperdal part, when they are selling Risperdal to children, even though they know that Risperdal, of all the drugs in that class, is uniquely dangerous to children, that it causes some 10 per cent of boys to grow breasts and an even greater percentage of young girls to start lactating. So what’s the worst of all that? I’m a little uncertain; it depends on what you see as the worst.

Cover of The Dark Secrets of Johnson & Johnson: Inside the Global Pharma Giant’s Scandals. | Photo Credit: By Special Arrangement

Through the book, we also get the sense that there are other pharma companies that are doing corrupt or criminal things. So why did you choose to focus on this one company?

This is not a big pharma book. There are big pharma books that look at the industry writ large. And there certainly are reasons to say that the pharmaceutical industry in the United States has pleaded guilty to more criminal charges, paid more fines, than any industry ever in American history. I think it is a facile thing to decide that the entire industry is terrible. On the one hand, we had a company that was among the most admired brands in the world, and on the other hand, in my opinion, they were by far the most poorly behaved. How did Johnson & Johnson get away with this for decades, and how did the company engage in such deadly behaviour, yet its executives were never prosecuted? That was another question that just haunted me.

What kind of challenges did you face during your reporting?

The challenge in this work is getting the right documents. If you are going to accuse a company of being engaged in behaviour that leads to two million deaths, you need more than off-the-record interviews. You need the goods, and you need the documents. Getting those grand jury files, which included a lot of secret internal company documents, was the only way that I could persuade a publisher to publish those allegations. I am so grateful to the people who put themselves at risk, who defied criminal sanctions to give me those documents.

You mention a couple of executives who were the chief antagonists. But would you say it was the culture of the company that made it behave this way for so long?

Johnson and Johnson developed this culture of impunity. They did bad things, and instead of being punished for it, they were lauded. That created an incredibly toxic internal culture in which they gaslighted their own employees and maybe even themselves into thinking that this behaviour was not only okay, but positive and laudatory. That behaviour then ended up continuing through generations of executives.

Signage is seen outside of the FDA headquarters in White Oak, Maryland, US, August 29, 2020. The journalist and author details Johnson & Johnson’s history of selling products linked to cancer and other serious health risks. | Photo Credit: Andrew Kelly/REUTERS

How and when did the FDA become so corrupt and ineffective?

The crucial moment for the history of the FDA is 1992, when the FDA, along with industry and the political class at the time, decided to take industry money for its operations. And basically, more and more, the FDA’s operations ended up being funded directly by drug makers. So, of course, drug makers, and especially the large drug makers like Johnson and Johnson, ended up running the agency, and their priorities ended up becoming the agency’s priorities. And to this day, when FDA officials give talks, they refer to the industry as their most important customers, and they don’t say that about the American public.

To what extent would Indians have been affected by some of these flawed and dangerous products you write about? 

As a book that just came out [one of the company’s products] showed, Indians have been victimised by nearly all of these products. Regulatory agencies in much of the world looked to the FDA and its decisions, and largely followed those decisions, because the FDA was seen as the gold standard. I think in many of these decisions, the Indians took their cues from the FDA. 

The people who came forward, the whistle blowers, were mostly sales representatives, rather than doctors or scientists or executives. Why did it turn out that way?

 I think if you go to medical school, if you go to law school, certainly you are smart, you have done well, but you are looking for financial security in your life. You play it safe, and unfortunately, that seems to make it hard to do the morally right and brave thing, because you have decided that you want a comfortable life and doing the right thing, in these cases, threatens that comfortable life. 

The kind of corporate culture you describe at Johnson & Johnson, does the same kind of culture exist in other American companies? 

This book is about Johnson and Johnson. It says a lot about American governance. It says a lot about American capitalism that a company can get away with this. It says a lot about American health care. But I think it is a mistake to say that Johnson and Johnson is the norm. It is not. It is uniquely bad.

But don’t they also do some good work?

Of course. They have some life-saving products. Wonderful. But that is what they should be doing, right? The fact that this company does some good things and has some good products should not be news.