Johnson and Johnson, America’s Most Admired Lawbreaker

http://highline.huffingtonpost.com/miracleindustry/americas-most-admired-lawbreaker/

by fahimulhaq • 11 years ago

164 138 11 years ago

highline.huffingtonpost.com

brento• 11 years ago

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?

sp3322• 11 years ago

(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_• 11 years ago

(TL;DR of the TL;DR)

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

werber2• 11 years ago

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?

thehoff4• 11 years ago

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."

danso2• 11 years ago

“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

werber2• 11 years ago

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

imperio59• 11 years ago

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".

thehoff4• 11 years ago

Following through the links to Dollars for Docs:

https://projects.propublica.org/d4d-archive/companies/johnso...

How is this legal? I'm ignorant of the details but for instance, if you click on California and look at Speaking, top of the list doc got $86,550!

danso2• 11 years ago

It's legal in the way that celebrity/professional endorsement is legal in any other field. It's not inherently wrong, and you would expect that an ostensibly effective product would be touted by respected professionals. And just to be clear, when speaking for the product, the doctors generally must stick to the company's slides and official talking points -- though the doctors have final say over what they present [1].

This is again, not necessarily evil -- in fact, it's a logical continuation of the law which mandates that companies only promote their drugs exactly and only for what FDA regulations approved the drugs for. The problem, as presented in the OP, is when doctors unofficially (i.e personally) endorse/promote/heavily prescribe drugs for off-label uses. Again, not an illegal thing on its own, as doctors are trusted to prescribe what a patient needs based on their professional judgment (or else, Dr. "House, M.D." would be in prison)...but the worry is that a financial relationship with a company (i.e. the payments for touting the official line) have the potential to taint a doctor's professional judgment.

[disclosure: I used to work at ProPublica and on the Dollars for Docs project]

[1] http://www.propublica.org/article/double-dip-doctors-paid-to...

mtgx• 11 years ago

Is that why they ask for strong patent law? So they can use those profits to pay for fines because of their recklessness?

thehoff4• 11 years ago

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.

scratchandsniff• 11 years ago

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

jonstokes• 11 years ago

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.

LordKano8• 11 years ago

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.

aggie2• 11 years ago

Vaccination is not an onerous requirement and there is very good reason to believe it is beneficial to public health when widely administered. If you want to reject it on principle alone, you'll have to address why your liberty in principle is more important than my health concern in practice.

Retra7• 11 years ago

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.)

a3n• 11 years ago

It's a tough question, and I acknowledge your position.

However, the very nature of state as we know it is to have the power of compulsion over many things. It's a spectrum.

wehadfun3• 11 years ago

I would guess that most of the anti and pro-vaxers are not scientifically trained, were not involved in the development or testing of these vaccines, probably have not read any of the original reports, don't know what influences could have effected those reports and are basically regurgitating info they saw on TV or the internet.

I've heard both sides of the vaccine argument and they both have points.

afarrell• 11 years ago

This is true of > 95% of any non-obscure public policy debate, is it not?

leoc2• 11 years ago

I've heard both sides of the vaccine argument and they both have points.

Would you expand on this?

roc• 11 years ago

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

Yes; they do not have a point as regards vaccines.

Because vaccines are so essential to public health, they're very closely regulated and monitored by the FDA. Samples from each and every lot of each and every vaccine are passed to CBER and tested (for efficacy, sterility, etc) at several stages of production, and licenses for distribution are granted per lot, based on passing those tests.

The FDA knows exactly what they want from these drugs, what the active agents are and how they work, and how to test for them. They don't accept cleverness or variations. There's essentially no profit in this process and no room for profit.

ZeroGravitas• 11 years ago

There's also the non-profit-driven evil you need to worry about:

https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

tcdent• 11 years ago

anti-anti-vaxxer

Vaxx yourself, force your wife and child to vaxx, create a policy of only befriending vaxxed people, but the next time you think about telling me what to do, you can fuck off.

dang• 11 years ago

Please don't take HN threads on off-topic flamewar tangents.

webnrrd2k• 11 years ago

The OP is strongly worded, but I don't think he's starting a flamewar. it's true that this kind of behavior on the part of pharma damages their credibility and feeds some people's paranoia. Just like the mishandling of the Katrina disaster feed a lot of people's paranoia about "big government". It might not make strictly logical sense, but the damage is still done.

cs702• 11 years ago

"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...

Highly recommended if this is of interest to you.

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

deelowe2• 11 years ago

In a typical corporation, psycopaths are the cream that rises to the top. I've seen it happen time and time again.

EyeballKid• 11 years ago

Or, as Jarvis Cocker put it: "Shit floats" :-)

cheepin• 11 years ago

"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• 11 years ago

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.

crististm• 11 years ago

I think your only chance is to start over.

agentgt2• 11 years ago

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.

drzaiusapelord2• 11 years ago

doctors rarely have time to do research on the samples that they were given.

Maybe back in the old days, but now with instant journal access, instant press access, etc its really not an excuse.

Self-compliance and regualtion isn't all that terrible especially when the alternative is underfunded and politically controlled organizations like the FDA. We like to believe in this myth that they're above the fray when it comes to commercial and political interests, but that's just not true. The FDA has no shortage of whistleblowers.

This attitude of "OMG IF ITS NOT 100% SOCIALIZED ITS SHIT" is extremely questionable. I don't know why its taken up uncritically on internet forums. One of the nice things of US society is that we have a more sophisticated idea of public/private partnerships which leads to interesting outcomes. This builds a lot of flexibility, creates investor confidence, and is just better business. For example, why are all these miracle drugs from the US and not from, say, Greece? Its clear there are many, many advantages to the US system. Silicon valley wouldn't have existed in a high regulatory environment, yet here you are on a forum dedicated to technology startups largely centered in that area and derived from that culture.

Retra7• 11 years ago

Why do you attribute the US's success in this area to its economic system and not it's massive population, fertile & expansive territory, socio-political isolation, and worldwide military presence?

refurb• 11 years ago

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?

agentgt2• 11 years ago

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).

calibum• 11 years ago

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

petra2• 11 years ago

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

datashovel• 11 years ago

“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".

6stringmerc• 11 years ago

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

pricechild• 11 years ago

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.

fisherjeff2• 11 years ago

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.

everyone• 11 years ago

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

https://www.youtube.com/watch?v=HmlX3fLQrEc

tracker14• 11 years ago

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

Theodores• 11 years ago

Same company, different drug, same story:

http://www.amazon.com/Blood-Medicine-Blowing-Deadliest-Presc...

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.

codyb• 11 years ago

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.

Johnson and Johnson, America’s Most Admired Lawbreaker

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