
Johnson and Johnson, America’s Most Admired Lawbreaker - fahimulhaq
http://highline.huffingtonpost.com/miracleindustry/americas-most-admired-lawbreaker/
======
cs702
"Tragic" is the only word that does justice to the events described by this
article.

The most interesting aspect of the story for me is how the company's culture
has changed for the worst over time.

Johnson & Johnson was started and for many decades was run by sincerely
idealistic do-no-evil entrepreneurs, who wanted to focus on "patients first
and profits last"... but now this business is run by executives who seem to be
doing _the exact opposite_ while claiming to abide by the same values.

This is a huge challenge for successful founders: how does one ensure that a
company's culture and values don't degrade long after the original team is
gone?

The author, Steven Brill, a successful entrepreneur and writer[1], wrote
another powerful long-form article about the insanity of healthcare bills in
the US a couple of years ago:

[http://time.com/198/bitter-pill-why-medical-bills-are-
killin...](http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/)

Highly recommended if this is of interest to you.

\--

[1]
[https://en.wikipedia.org/wiki/Steven_Brill_(journalist)](https://en.wikipedia.org/wiki/Steven_Brill_\(journalist\))

~~~
cheepin
"This is a huge challenge for successful founders: how does one ensure that a
company's culture and values don't degrade long after the original team is
gone?"

More than just a founder problem. This has been a defining problem for empires
throughout history: how to make sure the next guy doesn't mess it up.

~~~
daemin
Kind of a tangent but this point has really been demonstrated to me by the
game Crusader Kings 2. Where I'm trying to carve out a huge empire, only to
have my guy die and my heirs divide up the land and mess things up. It ends up
being really hard to have the empire continue as a whole.

In another way I'm also reminded by the family companies (hotels?) in Japan
that have been going for a thousand years, where they adopt grown people into
the family to continue the family business.

------
codyb
It's hard to know what to think in regards to big pharma. One conclusion I've
come to in recent years is that the EPA should have the funds to actually do
the testing themselves (as opposed to receiving results from the automotive
manufacturers for example), and so should the FDA. This idea that companies
won't submit doctored results to these standards we provide as a nation is
laughably false, clearly.

Another thing is that _somebody needs to go to jail_. And it should be from
the top of the chain to the bottom. If you're a sales rep dealing with
pamphlets which you've explicitly been told can't be left out in case of
regulators, your options should be "whistle blow" or be held accountable along
with the rest of that chain.

In a country with over two million people in jail you'd think we could nail
one of these bastards. It's just so gross.

Then there's all the issues with the US Taxpayer directly funding vast amounts
of the research that goes into these pharmaceuticals and not receiving
anything in return (except for exorbitant unregulated health care costs). The
taxpayers need to benefit from the corporate profits which come from taxpayer
funded research.

I'm not exactly sure what to think about all the advertisements for drugs on
our tvs and to our doctors. Most of me thinks it's disgusting. I'm not one to
think there should be a profit motive in healthcare as it can lead to awful
stories like this (I'm done with chapter one, I figure I can do one a day).
Unfortunately these are, at the moment, opinions, and I can in no way fully
flesh them out, offer concrete evidence as to why it should be any other way,
or really truly expand on the issues. That'd be a post of it's own and a few
weeks research I think.

Something needs to change though.

------
agentgt
My mother was a pharmaceutical sales rep for many years where she did rather
well despite her age most likely because she was previously a RN. I say age
because the pharma companies blatantly hire "sexy and young" to sell to
doctors. Now I'm sure there are other companies that age and appearance
discriminate but the pharma companies are especially egregious in that they
really don't care if the sales person is qualified or not.

And this is important because the doctors rarely have time to do research on
the samples that they were given. So its sort of a good thing to give the
doctor as much info as possible but this rarely happens as pharma sales person
Barbie and Ken could care less.

Pharma sales have strict compliance but guess who enforces those compliances?
The pharma companies. Not the FDA. So guess what they use the compliance
issues for... to get rid of older employees or to screw over other companies
(ie tattle telling).

Its completely fucked up.

~~~
refurb
_Pharma sales have strict compliance but guess who enforces those compliances?
The pharma companies. Not the FDA._

This isn't correct. Sales reps main role is promotion and the FDA has
jurisdiction over drug promotion. There are been several examples of the FDA
coming down hard on companies where drug reps fall outside of regulations.

In fact, most of the non-compliant behavior is reported to the FDA by _other
competitors_? What better way to hammer your competition than to rat them out
to the authorities?

~~~
agentgt
The FDA has jurisdiction but they are not the ones enforcing the rules. And
yeah the sales rep main role is promotion but there are electronic tests that
are given to each sales rep that are not given by the FDA but by the pharma
company. These tests are about getting signatures and information sharing. ie
there are rules how they can promote the drug and most of those rules are
about getting signatures and revealing key information about the drug.

I would say almost all of the compliance issues are sales reps forgetting to
get signatures or getting the wrong signature. This is not what the other
pharma companies tattle tell on as its a minor issue that is waste of time for
the other pharma company to go to the FDA with.

Lets say the pharma company is unrolling a new drug or wants to try new sales
tactics.. they will use use the signature compliance issue to fire sales reps.
They will threaten the employee that they can report them to the FDA. Bare in
mind that they collect these electronic signatures. And this is a serious
termination that benefits the company since they don't have to pay various
taxes (as opposed to laying off people).

I'm just curious refurb are you in the industry? I could be wrong that this is
done by all pharma companies and this was just an isolated issue (ie bad
apple).

------
danso
> _“All the big pharmas have lawsuits,” the analyst concluded, sipping an
> espresso. “It’s just not a big deal.”_

A list of the $13B in fines paid by pharma companies just in 2009 to 2014:
[http://projects.propublica.org/graphics/bigpharma](http://projects.propublica.org/graphics/bigpharma)

~~~
werber
It looks like the majority are mental health drugs, that's really scary.

~~~
imperio59
That's because these drugs are the mad scientist experiments of a bunch of
psychiatrists who are crazier than the patients they pretend to be "helping".
If you also look at how many mass shooters were on these drugs which were
prescribed off label and caused their violence, you start to realize the real
cost on society of these so called "cures".

~~~
sbov
In particular, SSRIs have been linked to increased violence in men aged 15-24
(but not other demographics), yet we continue to prescribe them to people in
that demographic.

------
thehoff
Great read so far, read Chapter 1 not realizing there were 15! I love these
long form reads where it seems like the author actually did an investigation
and is taking care to report.

On topic (again only got through chapter 1) I hope that J&J, or better yet
those actual PEOPLE, that were involved get punished. And not the _that 's the
cost of doing business_ punished. I doubt it but one can hope.

------
fisherjeff
This article makes it hard to stomach drug manufacturers' claims that drug
prices are so high due to regulatory burden.

J&J spent a lot of time and a ton of money to bring a new drug to market,
sure, but the only apparent improvement over the previous generation is their
own revenue. It's hard to believe this is an isolated incident.

------
werber
I'm really happy to see quality long-form journalism. Was Highline it's own
thing at one point or was it homegrown at the Huffpo?

~~~
thehoff
Reading around looks like it was homegrown, headed up by two people from the
New Republic.

From their about page:

"It's a new digital home for an old journalistic tradition. Think of it as a
magazine that only runs cover stories—big, ambitious pieces intended to change
the way you see the world or influence the course of policy. Investigations
will take months, essays will be finely considered, the subjects we choose to
write about will feel urgent and essential."

------
brento
This looks interesting and I'll bookmark it for later. Does anyone happen to
have a TL;DL version for those who don't currently have time to read the whole
thing right now?

~~~
sp332
(This is the first of a series of articles about J&J's regulatory
shenanigans.)

The Food and Drug Administration had prohibited Johnson & Johnson salespeople
from trying to promote Risperdal to doctors to treat children because of its
feared side effects, including hormonal disorders. The company was also not
allowed to promote it to treat the elderly except for the most serious
psychotic disorders; it was thought to cause strokes, diabetes and other
ailments in that population. But [...] Johnson & Johnson was reaping more than
half of its Risperdal sales from prescriptions written for children to
alleviate all kinds of behavior disorders, and for the elderly, who were given
the drug for simple symptoms of dementia or restlessness.

Johnson & Johnson emails, sales training manuals and business plans produced
as evidence in the case revealed that the company organized special sales
units illegally targeting doctors who treated the elderly and children. State
mental institutions treating children, whose drugs would be paid for by
Medicaid, were targeted, too.

When it came time to explain their conduct at trials and to federal
investigators, Johnson & Johnson executives and salespeople have unwaveringly,
even indignantly, defended themselves. One salesman, who otherwise fit the
salt-of-the-earth mold that R.W. Johnson had envisioned for his company’s
employees, gave thousands of Risperdal samples in child-sized doses to Austin
Pledger’s doctor in Birmingham, Alabama. Yet he insisted under oath in
February he didn’t recall stepping around kiddie furniture and toys as he
walked into an office with a sign that said “pediatric neurologist,” and that
he had no way of knowing that the doctor wasn’t treating adults.

~~~
mfoy_
(TL;DR of the TL;DR)

J&J pushed their dangerous pills aggressively, illegally, and
unapologetically. They targeted children and seniors.

------
scratchandsniff
Can this be the new standard for HuffPo journalism? Or do I have to tolerate a
dozen listcles and politically charged drivel before?

------
tracker1
I wonder if a shareholder could drive a lawsuit based on the violation of
corporate charter?

------
Theodores
Same company, different drug, same story:

[http://www.amazon.com/Blood-Medicine-Blowing-Deadliest-
Presc...](http://www.amazon.com/Blood-Medicine-Blowing-Deadliest-
Prescription/dp/0452298504)

This book is totally gripping and it also sheds light on the EPO scandal of
the cycling world. I do not recommend books lightly but this book is a must
read and also a literary 'secret' that is going to be made into a film. Add it
to your Christmas list.

I read it a while ago with my Dad reading it too. It was the best thing we
read that year - happy times, a book club of our own. Needless to say I have
sent this article on to him for his enjoyment.

------
datashovel
“Oh, they’ve already reserved for that stuff,”...

Is it just me or does this kind of attitude make you say "F __* YOU Wall
Street ".

------
pricechild
Reading through I found several diagrams in the articles were potentially
misleading. Images are scaled based on height rather than area, making 2x
increases look like 4x.

Thankfully the numbers are quoted which lets me form what I think is a better
opinion.

------
everyone
I recommend this documentary film about the 1% made by an heir to the Johnson
& Johnson fortune.

[https://www.youtube.com/watch?v=HmlX3fLQrEc](https://www.youtube.com/watch?v=HmlX3fLQrEc)

------
calibum
Until we start sending people to jail, such abuses will continue.

~~~
petra
True. And we should also target doctors that give shitty treatment as a result
of such shenanigans.

------
6stringmerc
Huh, and I already disliked the (loose) association with the Robert Wood
Johnson Foundation which aims for prohibition to return in the United States.

------
jonstokes
The tragedy here goes far beyond the direct damage to the patents who were
prescribed this vile stuff off-label. There's also the collateral damage to
the medical establishment that supports this -- can anyone argue that the
anti-vaxxers don't have a point when they're on about exactly this sort of
profit-driven evil from Big Pharma?

I myself am an anti-anti-vaxxer (a pro-vaxxer?) who actually supports state-
mandated vaccinations, but this puts me in the very uncomfortable position of
having to defend one corner of an industry that does the kinds of things
described here and a government that has failed at the most basic oversight.

So the next time you read about a measles outbreak at a theme park or you see
a scientifically illiterate ghoul like Jenny McCarthy peddling her child-
killing nonsense on TV, spare a thought for Johnson & Johnson, because they're
feeding the anti-vaxxer paranoia and kneecapping legitimate public health
efforts.

~~~
LordKano
The anti-vaxxers would have a point even if J&J wasn't involved in shady
activity.

I am not an anti-vaxxer. I was vaccinated. I had my children vaccinated.

I just hold the position that the power of the state shouldn't be used to
compel people to inject substances into their bodies, even if we think we have
a good reason for doing it.

I'm not looking to delve too deeply into the politics of it but there are good
reasons to oppose mandatory vaccinations.

~~~
Retra
Given that the whole purpose of a state is to compel people to do things, I'm
wondering what basis you have for drawing the line there. Or why a simple
waiver process wouldn't be sufficient to handle those who object.

In general, I would argue that a state has the authority to compel someone
into doing anything that has been sufficiently demonstrated to be a good
decision, and so the onus is on the anti-vaxxer to show that receiving a
vaccine is in fact not a good decision in their case (because it has been
shown to be valuable in general.)

~~~
LordKano
_Given that the whole purpose of a state is to compel people to do things_

I'd argue that the purpose of the state is to prevent people from doing
certain things. To illustrate, most of our laws are "Thou shall not..." versus
"Thou must..." to punish "bad" behavior instead of compel "good" behavior.

 _I 'm wondering what basis you have for drawing the line there._

Personal autonomy. Your body, your choice.

 _Or why a simple waiver process wouldn 't be sufficient to handle those who
object._

Because a waiver process implies that it's the government's choice and not the
individual's.

 _In general, I would argue that a state has the authority to compel someone
into doing anything that has been sufficiently demonstrated to be a good
decision_

Can the state compel everyone to be a vegan unless they can show proof of a
medical condition that would make it unworkable?

~~~
amyjess
> Personal autonomy. Your body, your choice.

Except that it's not your body.

If you don't get vaccinated, and you get sick, then you infect everyone else.
You don't have the right to choose to infect other people.

Vaccination needs to be mandatory, and if the state has to send agents to
burst into people's homes, tie people down, and forcibly administer the
vaccinations, then I'm all for it.

~~~
ygrechuk
I generally agree with LordKano, and in the same positions of having been
vaccinated myself and my kids. At the same time I really don't like state-
mandated vaccines. For philosophical reasons first of all ("Your body, your
choice"). But also for practical, as it presents a great possibility of abuse;
as an example impagine corrupt officials mandating unnecessary vaccination of
BigPharma's profit.

> If you don't get vaccinated, and you get sick, then you infect everyone
> else. You don't have the right to choose to infect other people.

I would NOT be against public schools mandating vaccines in order for children
to attend school. Same for places of employment.

~~~
chadgeidel
> it presents a great possibility of abuse;

I appreciate your concern, but this is a slippery slope fallacy. It's highly
unlikely it would be abused without knowledge, because we currently have a
net-good policy that is being "debated" at all levels today. I can't imagine a
net-neutral or net-evil policy would slip by undetected.

~~~
GauntletWizard
Slippery slope is not automatically a fallacy. In fact, since this is a
political (and more importantly, rhetorical) debate, slippery slope isn't a
fallacy at all. It is an argument, carrying some weight or none at all,
depending on how it is presented. In light of an article that is precisely
about how "Big Pharma" overprescribed drugs to people who didn't need them,
suggesting that allowing the government to enforce prescriptions will lead to
more corruption and overprescription, this argument should hold a lot of
weight.

More generally: Slippery Slope is a logical fallacy. It, along with many of
it's brothers [1], do nothing to prove a point in a logical debate. They do no
represent MUSTs, they represent SHOULD, MAY, and OPTIONAL [2]. These are
rhetorical devices that you should use when you are feeling out the scope of
the problem and advocating for policy in a political debate. And it can be
relevant to call them by name, but dismissing an argument because you can name
it is actually illogical.

[1]
[https://en.wikipedia.org/wiki/List_of_fallacies#Informal_fal...](https://en.wikipedia.org/wiki/List_of_fallacies#Informal_fallacies)
[2]
[https://www.ietf.org/rfc/rfc2119.txt](https://www.ietf.org/rfc/rfc2119.txt)

~~~
chadgeidel
Point taken. I should not have used that rhetorical device. Thanks for the
correction.

