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Radical Candor: Communication at Work
The Cult of The Credo: How a Beloved Brand Betrayed Your Trust 7 | 36
01:08:31
Behind Johnson & Johnson’s famous “Credo” lies a story of trust betrayed.
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- [00:01]
Gardner Harris
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- [00:33]
Amy Sandler
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- [01:03]
Kim Scott
Hello everybody. Welcome to the Radical Caner Podcast. I'm Kim Scott.
- [01:08]
Amy Sandler
I'm Amy Sandler. Today, I cannot tell you how excited we all are to be talking with author and investigative reporter Gardner Harris about what happens when a culture of silence and betrayal takes root at a company that created an emotional bond with its customers. He has written a book that we have all become obsessed with. It's called no More the Dark Secrets of Johnson and Johnson. A little background. Gardner Harris has written for outlets including the New York Times, the Wall Street Journal, the Courier Journal, and has done an amazing job holding powerful institutions to account, giving voice to folks who've been ignored. Gardner, we are so excited to, first of all, to welcome you. Thank you for joining us.
- [01:58]
Kim Scott
Thank you for writing the book.
- [01:59]
Gardner Harris
Thank you for having me. I'm so grateful.
- [02:01]
Amy Sandler
We are truly so grateful. And I think the big question that we all want to start with is why are we not all talking about this book? Why has it not been reported on? Why for all of us at Radical Candor and people we've been talking to, why are so many of the stories you're writing about, why is it the first time we're hearing about them?
- [02:20]
Gardner Harris
Right. Well, again, thanks for having me. I think one of the problems with the book is that I left daily journalism to do it. And like, I didn't do all of these stories in the newspaper beforehand. Books are really not normally a place for original stories, particularly original stories about one of the most iconic companies in the World, Right. Johnson and Johnson is a member of the Dow Jones Industrial Average. It is one of only two corporations in the United States with a triple A credit rating. The other one being Microsoft, a company you know extremely well. It is the largest healthcare products conglomerate in the world. It is a household name. And I am telling you stories about Johnson and Johnson that you have not seen anywhere else. And that is really discombobulating, I think, for the media ecosystem. You know, I was a longtime employee of the New York Times, rose to become the White House correspondent of the paper. I was a longtime member of the Wall Street Journal. Neither paper has reviewed this book. And I think a lot of it is because they don't really know what to do with it. I am accusing Johnson and Johnson of causing or contributing to the deaths of more than 2 million Americans. That's nearly twice as many Americans as have died in all the wars in American history. It's an extraordinary number. And again, like Purdue Pharma and the Sacklers don't come close. The kind of criminal actions that Johnson and Johnson has done or the kind of body count. And of course, when I was at the Times, we felled entire forests writing about Purdue pharmacists and. And they have done almost nothing about Johnson and Johnson in the wake of the book because I think they don't sort of know what to do with this. I have grand jury files. I have extraordinary documentation for all of these claims. But they are so extraordinary, I think, that they sort of let it go. They haven't reviewed the book. They haven't really dealt with the many claims in the book. And so it just kind of sits out there. And for people like you to kind of discover and go, wait a second, what? And as you have seen, you know, I have a whole website, I still need to work on this, of. Of thousands of documents, internal documents to Johnson and Johnson. I interviewed hundreds of executives. You know, one of the great things in the grand jury files I got. And by the way, when I say of grand jury files, I don't think the New York Times or the Wall Street Journal or really any major media organization has had a single grand jury file in more than 50 years. You know, I was a White House correspondent. We got national security top secret documents fairly routinely as you know, they show up in bathrooms at Mar A Lago and in garages in Wilmington, Delaware. But no one gets grand jury files. They are the last truly secret institutions in the United States. And I have hundreds of them.
- [05:33]
Kim Scott
How did you get them?
- [05:34]
Gardner Harris
Well, I got them from People who could not believe how this company, this iconic company behaved. And so were willing to break the law and give me documents that could put them in jail because this company has managed to avoid accountability for decades. And so I wanted to just sort of start this conversation by just giving you a kind of a waterfront. You know, this book. My main target is Johnson and Johnson, right? Which is this iconic American company. But the secondary and tertiary targets are really first. The FDA is a, as you know, big target of mine. I sort of feel bad using that word. But the description of the fda, that the FDA enabled and allowed all of these disasters and all of these deaths, it is almost wholly captive to the industry it regulates. The second, the third set of targets is the American professional class. The lawyers, the doctors. There are thousands upon thousands of them who were bribed, took money from Johnson and Johnson, and as a result, allowed their patients to die or. Or accelerated their patient's death because Johnson and Johnson paid them to do that. There are a lot lawyers who obviously lied under oath in countless proceedings in federal courts, lawyers working for Johnson and Johnson, outside lawyers, and they broke their oaths of office to do it. And then, you know, so the book really is sort of a question. And this is what we're going to get into about sort of American management. Johnson and Johnson has obviously been seen as a paragon of American management for a long time and also sort of about America's capitalist system. How can a company like this go so bad and almost no one know about it? And all of these institutions that we think are protecting us, the professional institutions, the bar associations, the medical boards, the fda, the inspector general's office, and even American media, are not really protecting us. I tell story after story about some of these. Journalists have tried to tell some of these stories for decades. And in case after case, Johnson and Johnson called up the headquarters of that media organization, said they would pull their advertising if that story ran. And the story didn't run. So really, in reading this book, it's a dark, dark tale. I think I do have a lot of suggestions about how to improve things, how we can get kind of beyond this. But it's a story that questions a lot of what I think many Americans believe about their lives, the system of governance, and even the economic system in which we live.
- [08:37]
Amy Sandler
There is so much in this book. One of the things that I think makes this book so compelling with your investigative journalism and reporting, is the storytelling. And you paint a picture of so many different products that I think any American, let alone folks, you know, outside the US can speak to how they or a family member have used this product, have an emotional reaction to a product. So before we get into the business related questions, the ethics questions, can you just talk about the range of products that you cover in this book? Because I think as people listen, their ears are going to perk up at what we're talking about.
- [09:16]
Kim Scott
Yeah, it's remarkable.
- [09:17]
Gardner Harris
Well, I will do that. And again, one of the points of this book is for readers to kind of begin to learn how to protect themselves against the standard ways that they are exploited in both American health care and sort of in our economic system. Because I tell stories about cancer, and cancer is one of the most corrupt forms of medicine in the American healthcare system. And I describe why it's corrupt and how once you get cancer, you can protect yourself against it. Same thing with orthopedic surgeons, just sort of that specialty writ large in the United States in terms of the amount of money that they get from manufacturers and how that changes how they practice medicine. And so I'll just go through, obviously, the first story I tell is baby powder and how a company kept hidden for 60 or 70 years the fact that it knew that this product contained asbestos and was poisoning the mothers and babies that it claimed to hold most dear. The second product I talk about is.
- [10:24]
Kim Scott
By the way, sorry, before we move off of that, there was this, there was a statistic, and I'm not going to quote it because I'll get it wrong, but there was a statistic, an estimate in your book about what percentage of ovarian cancers have been caused by Johnson and Johnson babies.
- [10:37]
Gardner Harris
15%.
- [10:38]
Kim Scott
And they knew for decades. It's like, you know, worse than cigarettes.
- [10:43]
Amy Sandler
So it was like the kind of stories, because I used shower to shower for probably over 10 years. And I feel like I had maybe heard somewhere something about it. But it was not until reading your book that it really came to light that this product, and certainly obviously the baby powder, that these were not messages that were getting out to the American public.
- [11:05]
Gardner Harris
And by the way, the FDA just held an advisory committee hearing on talc in which the FDA commissioner, today's FDA Commissioner Makari, said that science has conclusively shown since at least the early 1990s that talc is cancer causing, that it contains asbestos. So he said, basically in public, he said it several times, that Johnson and Johnson has knowingly sold a carcinogenic product to mothers and babies since the early 1990s. So, and by the way, David Kessler, the great FDA commissioner of the first Bush administration and the Clinton administration has said that the baby powder saga is the worst fraud committed on the Food and Drug Administration for the Food and Drug Administration's entire history. And it's a story that some people think they know, but I think I tell it completely and in a way that you have never heard.
- [12:05]
Kim Scott
Yeah.
- [12:06]
Gardner Harris
And again, I go through the proof that these executives and their lawyers knew what they were doing, at least since 1968 onwards. They knew that they were poisoning mothers and babies. They knew that this would lead to a jump in ovarian cancer cases. They knew that tens of thousands of women, at least, would die as a result, and they kept it up. And the story I tell about baby powder is really the ladder down which Johnson and Johnson, which started the 20th century as a truly ethical company, and it was that ladder down which Johnson and Johnson decided to sort of descend. Because, of course, if you're willing to poison mothers and babies, you're willing to do almost anything. And so I retell the story about the Tylenol murders. Both of you all learned when you were at hbs. And that HBS case study did terrible damage because it allowed Johnson and Johnson to sort of put up this smokescreen of ethical conduct. By the way, the case study is wrong in almost every respect. The lesson that the case study says is a lesson that sort of resonates with radical candor, which is, if you're straightforward and you're honest with the public, even about disasters, and you pay the money that you need to, the public will reward you. The opposite lesson is true. If you lie to the public, if you pay off the FDA commissioner, if you, at every step of this process, essentially do what the corruption and. And worst thing, you will get away with it. And not only get away with it, but allow you to get away with countless other crimes in your future as well. Because Johnson and Johnson used that HBS case study to sort of. To essentially gaslight its employees, so that that allowed them to then do the EPO story, the cancer story that we tell about how the most popular drug in cancer, from 1990 through 2007. So basically, the administrations of Bill Clinton and George W. If you had a family member die during those periods, there is about a 50% chance that Johnson and Johnson caused or sped their death because they were given this drug. And again, the story tells the tale about how the entire cancer community, every single oncologist, every single cancer hospital, was in on the crime and knowingly so. Right.
- [14:44]
Kim Scott
Because that was like that drug. Somebody called it miracle grow for tumors like that.
- [14:51]
Gardner Harris
Good for you, Kim.
- [14:53]
Kim Scott
That stuck in my mind.
- [14:55]
Gardner Harris
It's a nice line.
- [14:56]
Kim Scott
My mind.
- [14:56]
Gardner Harris
Yeah. And to this day, by the way, a huge share of American oncologists continue to give it to their patients because it makes them so much money. And then I tell the story, of course, about antipsychotics and Risperdal. My former colleagues at the New York Times, the Wall Street Journal, routinely referred to the opioid crisis as the worst public health crisis in American history. It's not. It's not even close. That's the antipsychotic crisis. More than a million Americans have died from this, and largely because Johnson and Johnson paid psychiatrists to use these drugs in wildly inappropriate ways. And, you know, one of the sort of, almost the side stories that I tell is why was Covid so destructive to American nursing homes in the United States? Well, a huge share of American nursing home patients are given antipsychotics. How do antipsychotics kill you? They make you more susceptible to respiratory infection along with strokes and heart attacks. What is Covid? It is a respiratory infection. So. And again, this is a story that none of my colleagues have told. Why was Covid so bad in American nursing homes? Because Johnson Johnson had been so successful in its criminal scheme to get nursing homes to use American antipsychotics.
- [16:14]
Amy Sandler
Can we pause on that one? Because I will say my dad passed away at the end of 2020. He had Alzheimer's. Sadly, that is a disease that so many of our listeners, I'm sure, have loved ones. What are the dangers of that medication? Why is it being prescribed? Can you just give us a little bit more info on that?
- [16:30]
Gardner Harris
So a top FDA official described this as mass euthanasia with plausible deniability. Antipsychotics are used in American nursing homes, and there have been plenty of studies that show this, that as staffing costs rise, so do the use of antipsychotics. Because what happens, as you know, Amy, somebody who has dementia or somebody who has Alzheimer's, they frequently wake up in the middle of the night and they're confused. They don't know what's going on. They cry out. And you need staffing to respond to those needs, right? Whereas if you knock them out, if you sedate them so that they sleep through the night, you need far fewer nurses or other staff on staff at night. So there are many American nursing homes that will not accept you. And unless you're on an antipsychotic for precisely this reason, you can go on this website of the Centers for Medicare and Medicaid services, the most expensive program in the federal government, far more than the Defense Department. And they actually have. They will show you the nursing homes in the United States and the share of patients who are on antipsychotics. There's a little asterisk to that I can talk about. And there are many nursing homes in the United States where every single patient is on an antipsychotic because it's cheaper for them.
- [17:54]
Kim Scott
And I think part of this story and getting sort of pulling on the thread of what's hard for a lot of people to come to grips with is the systemic problem here.
- [18:04]
Gardner Harris
Sure.
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Kim Scott
Like, a lot of those nursing homes are owned by private equity firms. It's like the combination of the financialization of our economy plus this kind of corruption of the medical. Like, it's, It's. It's breathtaking.
- [18:21]
Gardner Harris
Yeah. So then, of course, I retell the opioid crisis as we were talking about before. And the story that everyone knows in this country is that Purdue Farm and the Sacklers caused the opioid crisis, that OxyContin, you know, what sort of alone caused this terrible crisis. And Patrick, I read Keith's wonderful book Empire of Pain. Patrick's book is in many ways the standard business book. Right. Which is that Patrick told a story we all knew. My colleague Barry Meyer first told the Purdue Pharma story in two iconic landmark stories back in 2001. And what's amazing about Barry's stories is that he had every element that of Patrick's book in those original stories, you know, 20 years before Patrick's book comes out. So Patrick does this wonderful retelling of a story we all know that tells us that it was really Purdue Pharma and the Sacklers who caused this crisis. It's just not true, unfortunately. About 1 in 10 bodies that showed up in morgues during the prescription opioid crisis that showed up had a Purdue Pharma, a Sackler product in their system. Six in ten had a J and J product in their system. J and J was far more important to the proliferation of opioids and this terrible crisis than Purdue Farm and the Sacklers. But Purdue Farm and the Sacklers were a tiny player. It was a one product company based in Bristol, Connecticut. It was not systematically important. It didn't have consultants in every major academic medical center across the country. It didn't have this army of lobbyists in Washington. It wasn't one of the largest funders of media organizations through advertising in the country. So it was just. It was a very soft target. So that's why you think, you know, the Purdue Pharma and the opioid story. It's not the case. The other thing that's kind of important to know about the opioid story is that in a lot of these stories, I tell you the Risperdal story, I also tell you the story about metal on metal, hip implants, vaginal mesh, propulsive. In each one of these cases, these products offered zero benefit to people. Same thing with Johnson's baby powder. There's no medical benefit to Johnson's baby powder. So there's no way you can balance the risk of the asbestos contamination with something that might benefit you. Opioids have benefits. If you're in serious pain, there is no drug that will treat your pain nearly as quickly or as effectively as opioids. So the opioid crisis is, in many ways, of the nine crises and disasters that I relay in this book, even though there's a huge number of deaths, it's in many ways the sort of the least blameworthy because, again, it's kind of tough to separate out the patients for whom opioids were appropriate therapy and patients for whom it wasn't. Clearly, Johnson and Johnson did this. It expanded opioids use to those with lower back pain, mild pain, for which the risks of the drugs didn't balance out their benefits. But opioids have real benefits. And that's why, you know, while everybody sort of thinks the top of corporate greed is Purdue Pharma and the Sacklers and opioids, I really kind of argue in this book that that's not it at all. What you think, you know, is completely wrong. So anyway, and I can talk about, obviously, the metal on metal hip implants, the vaginal mesh. You know, these guys attacked the. The. Look, I tell several stories in which they knowingly killed babies. Right. The repulsive story is. Is. Is really the story that led me to do the book. And we can talk about that. They went after preemies. They went after preemies and killed dozens of them. And so there are all these products like Johnson's baby powder, in which they knowingly wounded infants and children, the most innocent people. Exactly. But there are also all these products in which they targeted women's reproductive organs. Organs. You know, the baby powder one I deal with just sort of almost as a sidelight, is the little blender that they used to do hysterectomies. And these were for these laparoscopic procedures. And the blender would go in there and chew up the uterus within a woman. And what they knew would happen is that if there were any cancerous cells in there. And as you know, endometrial cancer is really hard to diagnose. And roughly one in 300 women who got this procedure died because, my God, the procedure would splatter these cancerous cells all over a woman's abdomen and it would make it impossible to treat. And these women would die fairly quickly. And it's again, they're one of the largest manufacturers of breast implants. They refused for decades to follow how women did on their breast implants. And of course, finally last year, the FDA finally put warnings on breast implants that they do indeed cause a rare form of breast cancer. But you know, why are we just now finding out about it now? Because Johnson and Johnson refused to do what they promised to do by following women. And then there's Orthoevra, the birth control patch where they lied to the FDA about the amount of estrogen in this patch. It was twice as much estrogen as they said. They essentially sold a product that was like the original pillar sold in the early 1960s. Thousands of young women had blood clots, strokes, heart attacks. Thousands died. They knew about this. They lied to the FDA about it. And it took years for them to sort of admit what they had actually done. So the story of Johnson and Johnson is a story of a company doing exactly the opposite of what we believe about them. Because of course, we all think that Johnson and Johnson's the most ethical, the most forthright company on the planet. And it's just the opposite. And it's a really interesting tale how.
- [24:41]
Amy Sandler
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- [25:54]
Gardner Harris
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- [26:01]
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- [26:32]
Kim Scott
It'S so interesting, Gardner, because when Brandy sent me an email about the book, and I am, I would say, like, wide open to the message, I'm a skeptic about the way that we practice capitalism right now. I've gone down the rabbit hole on the problems of capitalism and why we need better regulation. I worked in the federal government, I worked at the fcc, and coming to grips with some of the terrible things we unleashed. So I've been thinking a lot about this, but as soon as I got an email that said, you know, this makes the Sackler family look like nothing, and I was skeptical, by the way, of the credo challenge in radical candor, I wrote a little bit about it because you would think I'd be, oh, yeah, I gotta read this book right away. And my first instinct was, oh, no, this can't be right. Like, so deep is. I mean, luckily, Brandy persuaded me to overcome my high prejudice, but, like, so deep is this idea that this is a good company and that the Sacklers were a bad apple, but the system is okay. It's not okay.
- [27:40]
Gardner Harris
Yeah, well, you know, I tell the story about how that happened, which is that Johnson's baby powder is the most extraordinary branding tool ever devised. At its height, half of all American babies had their bottoms dusted with Johnson's baby powder. It has this extraordinarily distinctive smell that comes from this floral 200. You know, there's jasmine in there, overtones of citrus. Johnson and Johnson's own surveys show that it is the most distinctive smell on the planet. As a baby, the best thing that happens to you is when your mama comes to you and coos with you and wipes your bottom of this horrible stuff that somehow got there, right? And. And so, along with this wonderfully loving moment comes this smell. And as we all know who've done any brain work, the smell is the one sense that is most closely associated with emotions because the two parts of your brain, the smell center and the emotional core, the. Are right together. So it's why, like, when you smell a distinctive smell, it's the one thing that can bring back memories like nothing else in.
- [28:48]
Kim Scott
Right.
- [28:48]
Gardner Harris
Yeah, right, exactly. Proust. I quote Proust in the book about this.
- [28:52]
Kim Scott
Yeah.
- [28:52]
Gardner Harris
And so you have essentially been born with this brain worm that. That makes you think Johnson. When you think Johnson and Johnson, you think wonderful stuff. And it used to be, by the way, that Johnson and Johnson executives invariably, for decades, they would. When they would give their speeches, they would say, when I say Johnson's baby powder, how many of you can just smell it? And the whole room would light up, and it was almost like. It was almost like they'd been hypnotized. And so whatever followed, whatever they said subsequently, the room just accepted in a way that they. And Johnson and Johnson knows this. There are these internal analyses that I quote, that Johnson and Johnson has. That many companies have rational trust. Johnson and Johnson has emotional trust. And it's why I decided that I had to do a book, because I did a couple of these stories in the Times over the years, and everyone would say to me, oh, well, maybe they did one thing wrong here, Gardner, but it's a great company. I mean, you just could not penetrate.
- [29:56]
Amy Sandler
You almost have to, like, counteract all of that programming. It's so interesting when we teach radical candor. You know, one of the things Kim said was that, you know, for. Why is it hard to challenge directly? Well, how many of you got a message when you were 18 months old? If you don't have anything nice to say, don't say anything at all. So it's like we're having to go against that wiring. So we have the smell wiring, the emotional connection. And then for Kim and I, you referenced the Harvard Business School case study. This was an example. And my backroom was in executive communications, so I went through my adult career thinking this was an example of how to handle a crisis. And so not only do we have to give up our lived experience of the emotional connectivity, we have to give up what we've learned, and then we have to give up believing all of these institutions were actually doing what they thought they were doing. And so I just. There's. There's so many pieces to this puzzle. The individual stories of people who you. You mentioned about oncologists or orthopedic surgeons. I mean, I have had great fortune to. To have great care from a variety of medical professionals. Let alone people I love who are in these professions who are doing such good work. So I'm loathe to kind of paint a whole profession with that brush. But I'm just curious, what is it in the examples of people in those professions? What are the incentives that causes someone to go from a Hippocratic oath and wanting to do the right thing into actually starting to, you know, be motivated by different incentives?
- [31:34]
Gardner Harris
I'm sure you've talked about it a lot. Conflicts of interest, right? Which is, you know, there's been any number of people who have pointed out that when your pocketbook depends upon you believing something, you will believe it fiercely. Right. And so many of these people are indeed wonderful people in the way. One of my favorite ways of demonstrating how conflicts of interest work is to reference this great study that was done in 2000 at University of California San Francisco Medical School. They surveyed residents about whether they thought money and gifts from pharmaceutical sales representatives influenced their own prescribing and whether they thought that these gifts influenced the prescribing of their colleagues. And of course, 20% conceded that maybe their own prescribing might be influenced. But 80% thought that they're. Yeah. And this is that Garrison Keiller, you know, we're all, you know, above average here sort of idea, and that is that money corrupts even good people. And the story of IPO in particular shows just how corrupting that influence can be. Because this was a drug. Epo. How we all know EPO is really about Lance Armstrong. Most people know that Lance Armstrong and his team used EPO to dope and win seven tours to France. You know, it's. It's this product that increases the num. Your body's production of red blood cells. So if you're a high level aerobic athlete, like bicyclists, it's this wonderful thing. It'll. It, it's like, you know, if you use epo, it's like you've been, you know, working out on the top of Everest, you know, because it sort of turbocharges your blood with red blood cells and allows you to much more efficiently get oxygen to your muscles. And so it's a great doping mechanism. But the real use of epo, the largest use, and it was by far, it was, by the way, the largest single expense of the federal government during the height of its use. Not building aircraft carriers. Not, not, you know, all the things you think about.
- [33:49]
Kim Scott
EPO was the single EPO for cancer patients.
- [33:52]
Gardner Harris
For cancer patients. Right. And that's because Johnson and Johnson and I've heard that McKinsey actually helped them come up with this idea. Johnson and Johnson decided, hey, originally, EPO was sold just for patients who were getting kidney dialysis, because when you get to kidney dialysis, your blood gets out of your system. It goes through these filters, and it. And the filters often destroy red blood cells. So people who go through kidney dialysis are often anemic. Anemia is often a measure of your number of red blood cells. So the first idea was, we'll give this to patients on kidney dialysis. They'll need fewer blood transfusions. Blood transfusions come with their own risks. Johnson and Johnson invested in this in a complicated deal. And Johnson and Johnson got all sales outside of kidney. And that's when Johnson and Johnson decided, why don't we sell it as sort of a kind of a pick me up for all cancer patients? You know, because chemotherapy can lead you to become anemic and weak and all this sort of stuff. We'll give them a sort of a boost of red blood cells with this. It'll be great.
- [35:00]
Kim Scott
But they didn't need the red blood cells, right?
- [35:03]
Gardner Harris
So the thing about chemotherapy is that your red blood cells almost immediately replenish themselves as soon as you're done with that particular regimen. And so it wasn't really necessary. But Johnson and Johnson, what they did was they made this very expensive. And they told oncologists, look, if you prescribe this drug to your patients, you're going to make a huge amount of money. And so, very quickly, EPO became the most popular drug in cancer. And what happened is that oncologists, on average, made about $300,000 in their practices, and they made about $300,000 exclusively on prescribing EPO to their patients. It roughly doubled their income. Now, there was nothing that EPO did. In fact, we later learned that Johnson and Johnson knew the entire time that this would kill these patients rather than help them. But what Johnson and Johnson also did is it added about 15% extra EPO to each vial of EPO. The way oncology drugs are reimbursed is that doctors tell Medicare and private insurers, Look, I bought 100 milligrams of this drug. This is the price of the drug. Give me this amount of money. What Johnson and Johnson did was give doctors 115 milligrams of this drug so that they could treat some of their patients with freebie. So not only would they get the. There was always a gap between what they actually paid and what, they billed Medicare, but then, of course, that gap goes to 115% when they're getting free drug. So in almost every cancer hospital in the country hired what is known as compounding pharmacies. And these are these pharmacies that essentially repackaged EPO for them. So the way, you know that these hospitals were knowingly engaged in huge amounts of insurance fraud is that they hired a company to repackage epo. The only reason to do that is to be that much more efficient about billing for free product. And, you know, I have the grand jury files on the EPO investigation, and they called in some of the CEOs of these hospital systems and said, what are you doing hiring compounding pharmacies to repackage epo? And these guys all had their lawyers there, and they said, basically, I can't recall, I can't recall. They called in the compounding pharmacy companies, which, of course, there's no crime for them to repackage on their behalf. And compounding pharmacy companies just willingly said, oh, yeah, we repackaged it for them so they could charge you for free stuff. So hundreds of billions of dollars was stolen in insurance fraud, and just so happens nobody really cared. But about 500,000 patients were killed as well.
- [38:02]
Kim Scott
It's staggering. It's hard not to be left speechless by these.
- [38:06]
Gardner Harris
And these sort of incentives are all over the healthcare system now, right? I mean, yeah, I would argue that all of this stuff is getting worse, not better. Yeah, that. You know, I wrote, I was around before the communalization of health records. You were around that. Remember when you went into your doctor's office and there was this huge array of colored files behind the nurse's desk, and they would get down your particular file and you'd go to the doctor and he'd write it in. Well, nobody has that anymore. It's all digital. And the selling point for digitization of healthcare records was that you could then take these records with you. Your doctors could have coordinated care. Things like what are known as ACOs or accountable care Organizations could be set up where all of your care is managed as one. And also, poor medical care could be caught by administrators because they'd see the digital records. What's actually happened is that the digitization of healthcare has allowed for the proliferation of small but clear corrupt practices across the healthcare system, where these top administrators can sort of tell, for instance, if you had pancreatic cancer, you're going to get eventually a biopsy of your pancreas. And, you know, depending upon whether the cancer is in the front of the pancreas or the back of the pancreas will show you whether you're likely to live or not. But these surgeons have begun to do biopsies of the stomach, of all kinds of surrounding organs that in 99% of the patients is not needed, and adds just a little bit of risk to the patients. But each one of those biopsies is a separate. What's known as an ICD10 code, or, you know, it's a separate billing code. And those sort of practices basically become standardized across systems because of the digitization of records, where the administrators can say, look, your colleagues are making us twice as much money as you because they're doing these other procedures. Now, those procedures raise the risk for the patients. They don't really add any benefit for the patient, but it's a small risk. You can be persuaded to do it, and you are. And that sort of small level corruption with a small circle has become endemic across the healthcare system. I mean, you know, many of the people I talk about who are in these grand jury records, you know, these people get citizen of the year awards. These hospitals are seen as paragon of ethics. And yet they participated knowingly in a criminal conspiracy that cost 500,000 lives.
- [40:50]
Kim Scott
And I can imagine, as a doctor, like, what happens is there's plausible deniability. It can't. Like, you hear one thing and then you say, but this would never be happening in the world in which we live. Johnson and Johnson wouldn't do this. The FDA wouldn't allow it. Maybe that's wrong. And so you go down the path, you convince yourself, and this patient is feeling so lousy, and maybe this will help them feel better.
- [41:20]
Gardner Harris
Absolutely. And why not believe them? You are programmed to believe them. And it just so happens by believing them, you get another $300,000 that year.
- [41:31]
Kim Scott
So, yeah, yeah, there's. There's an incentive to believe what is convenient to believe.
- [41:37]
Gardner Harris
Just tell the brief story. The story I don't tell in the book is the real reason I did this book, and that was that my own son was born early. He spent several days in a nicu. It was a harrowing experience. And as a dad, you're just like, oh, yeah. And suddenly this little tiny being has its hands wrapped around the taproot to your soul. I mean, you had no idea. And, you know, this child of mine was in this incubator, and I was distraught, like, I had not been destroyed. And I lost my mother. I had all kinds of my grandparents, I had all kinds of Death. My best friend had died, but nothing like this had really hit me. And finally he came home, he was fine. But a few. This is back in the day where there was no such thing as paternity leave. So as soon as he got home, I went back to work and within days got a sheaf of documents from some sources showing that Johnson and Johnson had for years targeted NICU units to sell this heartburn drug called Propulsive, which on the one hand, it knew didn't work for babies. On the other hand knew that it, in rare cases, killed them. And I just was looking at these documents, like, what? And I, as I say in this book, I grew up in Princeton, New Jersey, near Johnson and Johnson's headquarters. A lot of the executives live up in Princeton, send their kids to fancy private schools. I went to the public school there. But we all grew up with this idea of Johnson and Johnson as the ideal American conglomerate that does well on the one hand, but also does good on the other. And as I did this, one of the first big controversies I did when I was at the Wall Street Journal was the AIDS in Africa story. The antiretroviral drugs had been developed in the United States. The American makers of that had set the prices at somewhere between 15 and $20,000 a year. No way anybody in Africa or very few people in Africa were going to be able to afford it. So we were going to see an entire continent die. Huge controversy comes up. And basically this controversy leads the American pharmaceutical industry to allow Indian generic companies to make these drugs essentially for free. And once my friend Hamid of Cipla gets the price of the triple cocktail down to below a dollar a day, they know that there's enough money to save the continent. Well, the one holdout of that controversy was Johnson and Johnson, one of the largest makers of AIDS drugs in the world, and just told the rest of the world to take a hike. We're not going to allow our drugs to be copied. It's not going to be part of this. Now, there were enough other drugs that Africa was saved, but if it had been up to Johnson and Johnson, Africa wouldn't have had a chance. And I just, I remember just being like, what? How is this possible? And then I have my experience with my own son and these documents and realizing that my son could have been one of those targeted had he been born three years earlier. And then I. This story about the sales rep in the airport that I tell in the book, which is that, you know, I was. I was on a ski trip in Colorado and had one of those layovers that we've all had at Chicago's o' Hare Airport and ended up sitting next to this sales rep who told me this horrifying story about selling Risperdal. And suddenly her nephew gets in a fight at a playground, is prescribed Risperdal by one of her favorite doctors. The child blows up. Right? Because children on Risperdal gain on average a pound and a half of fat every week. And that of course adds within four or five months. You're talking about 30, you know, 40 pounds and an 11 year old. 30 or 40 pounds of fat. They're a bowling ball. And. And this happens to her nephew. Meanwhile, Johnson and Johnson has done this terrible thing that I, as far as I know, has never happened, which is that the FDA mandated that Johnson and Johnson send to doctors a warning that Risperdal could cause diabetes and other metabolic problems, which, you know, again, read, yeah, massive weight gain. Johnson and Johnson does just the opposite. Sends letters to doctors saying Risperdal doesn't do this. All of its competitors do. If you're worried about this problem, prescribe Risperdal. And of course, it takes, you know, the FDA about a year to kind of get around to do anything about this. But finally the FDA sends another warning letter, said if you persist in this, we're going to prosecute you and find. But finally Johnson and Johnson sends a new warning saying that we'd lied before. But during this time, I meet this woman and she's, she's distraught because she has been told by her bosses that she needs to tell all of the, her doctors, you know, Risperdal doesn't cause weight gain. When she is watching her, watching it happen, blow up, and she tells me she's going to quit. And I tell her, you know, let me do a story about it. And you know, she leaves my card on the, on the bar and I never see her again. But that's where the, the book really starts.
- [46:53]
Kim Scott
I think that one of the things that people can take away is that when you notice something like this, even if you don't want to go public, talk to the people. Talk to people like the more that. I mean, because even though she wasn't a source, she had a huge impact on your decision to write the book. And so good for her for talking to you at this bar. You know, it doesn't sound like, you know, that doesn't sound like the salute. But sometimes just talking to someone, and maybe even just a stranger who doesn't even know who you are, might feel safer than talking to someone who, you know.
- [47:25]
Gardner Harris
Yeah. I mean, you and I, we had an exchange before our conversation. And, you know, arguably, I think Johnson and Johnson's unique skill, the one thing that Johnson and Johnson does better than anyone else is completely gaslight its employees. One of the great questions that, Kim, you sort of asked me to answer at some point in this conversation is how did they get away with this? Right. How did they persuade. You know, these are the stories that I tell, by the way, are the largest, costliest and deadliest criminal conspiracies in American history. Nothing else is close. You know, not Tycho, not Enron. All the big frauds that you sort of think of are tiny specs compared to this, compared to myriad ones that Johnson and Johnson prosecuted. Right, yeah. You know, and got away with. Right. And, and, and how is it that this company managed to persuade hundreds of its own employees, thousands of these doctors, to go along with these clearly, obviously criminal schemes? And it's because, you know, they are spectacular at gaslighting everyone about their own ethics. As you know, Kim, the sort of. The management thing, management lessons coming out of this is that, you know, Johnson and Johnson created this sort of cult of the credo. You know, we would pronounce the credo. They call it the credo, which is this, you know, the first real mission statement. Right, yeah. That is, you know, our first obligation is to mothers and fathers and, and doctors who use our products. And. And every corporate meeting starts with a credo discussion and there's this whole kind of, again, cult, as many employees describe to me, about how the credo informs our decision making. And so it's in many ways these cultural conversations became this early warning system for managers to, to. To be able to weed out possible whistleblowers before they blew the whistle. Because, of course, people would sort of say, well, wait a second, you know, yeah, Cradle said this and we're doing that. And that instantly became a way for them to sort of say to these employees, you know, this really isn't a good cultural fit. Like, you know, we're all credo focused and you really aren't getting the credo, so maybe you shouldn't go. And then the other thing, of course, is that Johnson and Johnson has noticed the Johnson family of companies. It's a conglomerate, it's got 150 different subsidiaries. And so there is this profound anxiety and unease amongst employees there because the company was always closing, shuttering and starting various subsidiaries and basically firing everybody in the subsidiary and forcing them to reapply for their Jobs. So if you had ever expressed any unease about some of the company's conduct among any of these disasters. And by the way, you know, the original manuscript, my original manuscript was twice as long with a whole lot more products and a lot more detail. My editors were like, carter, I mean, no one is going to be able to read this stuff. And I think they were right. So I have a huge amount of other material. And so they were able to sort of keep this vast, you know, these vast conspiracies. That's really the only work for them. And the vast number of coconspirators in line by, on the one hand, this sort of cult of the credo, and on the other hand, this constant churn of subsidiaries that they could bid out anybody.
- [51:06]
Kim Scott
Yeah. So everybody's afraid of being fired and so they're not going to speak up. And then they give them the opportunity to speak up and those who do are out.
- [51:15]
Gardner Harris
Exactly.
- [51:17]
Kim Scott
It's. And so, I mean, it's the, the credo. I never knew that's how you said it always.
- [51:21]
Gardner Harris
Yeah, I know. Well, someone is from Johnson and Johnson when they say they call the credo, it's kind of the credo. Yeah.
- [51:27]
Kim Scott
But anyway, it's like the ultimate manipulative insincerity. Yeah, that's what, that's what it's. That's. That's the way it's been used that.
- [51:36]
Gardner Harris
You talk about in your book. It is the ultimate version, as we.
- [51:40]
Amy Sandler
Were talking about manipulative insincerity. And there is a pattern of this sort of doubling down on the lies. What insights do you have, though, about why there were so many times when they could have come clean and the facts were presented and they kept lying or doubling down on it. What is underneath that? Is that just endemic to this company or is there something larger about human nature that you have some wisdom for.
- [52:06]
Kim Scott
Us or the system of capitalism?
- [52:07]
Gardner Harris
Yeah, I think, John, the story of Johnson's Baby Powder is such an extraordinary story and I think it really explains a lot of this. In our back and forth before we talk, Kim, you talked about how James Burke, the executive in charge of that is widely seen. I mean, Reagan gave him the highest civilian honor possible. He has long been seen as if not the most ethical business executive, one of the top. There are awards named after him. And it's very clear he knew exactly what was going on with Johnson's baby powder. You know, he completely changed a lot of processes at Johnson and Johnson to protect that franchise and the company writ large from these disclosures he is not even close to being in the pantheon of ethical business leaders. And I think what possibly happened is that the 1982 Tylenol poisoning scare. Johnson and Johnson did a series of appalling things. And by the way, there's a really good Netflix documentary about the Tylenol murders. I happen to be interviewed in, in that documentary that sort of retells that tale. And they don't even go into all the details about how almost certainly the FDA commissioner at the time was being paid off by Johnson and Johnson obviously illegal.
- [53:28]
Kim Scott
And they knew, Right. That this guy, this guy in their. I mean that was what was.
- [53:34]
Gardner Harris
They almost certainly knew who the killer was and didn't tell the investigators who this person was. So I think what happens is they kind of get away with murder, Right.
- [53:44]
Kim Scott
And then not just kind of, they literally get away with murder, are fetid.
- [53:49]
Gardner Harris
As amongst the most ethical people on the planet. And I. Yeah. And you know, if you take the cops entirely away from everywhere, are we all going to turn into shoplifters? Like if there is no possible consequence.
- [54:05]
Kim Scott
Yeah.
- [54:06]
Gardner Harris
For you going into the store and you just taking stuff and putting in your bag. How many of us are going to go in stores and take stuff and just put it in our bag? And I think these guys were not only able to go in the store and take everything and put in their bag, but then they were showered with praise and money as a result. And I think that kind of impunity that engenders a socio pathology which is the only way you can kind of describe Johnson and Johnson post 1982, was that it was, it was a sociopathic organization. And. And there is really no evidence that it isn't still right. I mean again in the baby powder case that finally the FDA finally does its own test of baby powder in 2019, finds Asbestos. Even though FDA has now confirmed that mothers and babies are being poisoned by this consumer product, the FDA doesn't make an announcement, tells it privately to Johnson and Johnson gives Johnson and Johnson roughly a week to get some sort of statement together. And in that week, Johnson and Johnson employees get together and have these marathon meetings about what to do. And there's this woman, Carol Montanbaum, who's a Johnson and Johnson executive, I believe to this day. She writes like 80 pages of notes of all these meetings. And those notes talk about FDA and blackmail and coercion and you know, what are they talking about? Well, she is. She is deposed a year later, just a year later. And when you wrote blackmail about fda, what were you saying, I don't recall. When you wrote Coercion, what were you saying? I don't recall. And the lawyer's like, is it normal for you to talk about blackmail and coercion when talking about the fda? No. By the way, this book, Fine, Tooth comb, multiple lawyers. I'm sure you know, we are charging obviously, one of the great American companies with participating in 2 million deaths, with causing 2 million deaths. I will tell you that there are foreign arms of my very large publisher who refuse to publish this because of the legal risks associated with it. So I'm so grateful for Random House for being brave enough to do it. The charges are searing and extraordinary. And we can only do it because of the extraordinary care that we took with all of these documents and interviews. And you have proof?
- [56:48]
Kim Scott
We have proof, yeah. Yeah. Well, I think one thing that people can do is buy your book and read it.
- [56:54]
Gardner Harris
So.
- [56:54]
Kim Scott
So I'm going to hold up my screen. There it is. Try to buy it. Yes. There you go. No more tears. It is, it's a really sobering book. But you also offer at the end a lot of hope about how we can create, you know, we need capitalism constraints. We need, we need real regulators who have real teeth. We need real rules of the road so that, so that greed doesn't, you know, isn't the only thing people are pursuing. And so that people are not rewarded for pursuing greed, you know, at the expense.
- [57:32]
Gardner Harris
Deadly greed concerns.
- [57:34]
Kim Scott
Yeah, deadly greed. That, that. So that people don't have an incentive to overlook the facts.
- [57:40]
Gardner Harris
Because I just want to be clear, there was almost certainly not a single American family that is, that has not been affected by these various things that I talk about.
- [57:49]
Amy Sandler
So I think for me, that's the big takeaway is that I said this should be required reading for every civilian, every mba, every md, every j. Everyone. Just as a professional, you know, Brandy sharing just her own stories. I really think it touches everyone. And it is shocking to me that we're not hearing more about this book. So I did feel like we had an obligation.
- [58:11]
Gardner Harris
Well, I'm thrilled you did. The one that really comes back to me when I give book talks is Tylenol. You know, Tylenol is by far and away the most dangerous over the counter medicine. Nothing else comes close. More people die from Tylenol than all other over the counter remedies combined. And, and it's a mess. And of course, one of the reasons it's so dangerous is that it's sold as so safe. And, and it's that when when people read that in the book, they're like, wait a second, you know, I had no idea. And, and it, and it's one of the, like, I don't think anybody should have extra strength Tylenol in their house.
- [58:47]
Kim Scott
That was one of the things I did when I finished your book is I, Me too.
- [58:50]
Amy Sandler
And I've had a bias of like I have to have the brand name thing and I'm like, I'm good.
- [58:55]
Gardner Harris
The FDA has sort of acknowledged that forever. But you know, again, in a sign of the FDA's powerlessness versus Johnson and Johnson, you know, has refused to backtrack its approval of extra strength Tylenol, although it now will not allow prescription drugs to have anything more than the regular strength 350 milligrams in. So it is the only pill where the over the counter medicine has nearly twice the amount of drug as the prescription medicine is allowed to have.
- [59:31]
Kim Scott
It's astounding.
- [59:32]
Amy Sandler
Okay, back to the hope.
- [59:33]
Kim Scott
Okay, hope. What hope? Give us a little hope gardener do we have? Well, everybody can throw away their extra strength Tylenol. Yeah, that's one step by other kinds of band aids.
- [59:45]
Gardner Harris
Well, so I think there are, you know, look, FDA needs to be a true regulatory body. It needs to right now. Most of FDA's funding comes from the drug and device industries. And FDA officials routinely go to these industry conclaves and say that FDA's most important customer is the industry. FDA officials say this. They do not say that the American public is their most important customer. They say that the industry is the most important customer. You can. And you know, I live in San Diego. It's a biotech hub. There's a lot of small biotechs here. I'm not saying that FDA does everything that every industry player asks them to do. If you, if you're a small player and don't have the kind of political muscle that JJ has, you know, they'll mess with you.
- [60:38]
Kim Scott
You're not getting any love.
- [60:39]
Gardner Harris
Yeah, you're not getting any love. But what I tell a story in the book about 2012, the FDA was about to face a disaster because the industry refused to re up these, these five year funding mechanisms. And the FDA commissioner of the day, Margaret Hamburg, called the J&J CEO and asked him to save the FDA. He then did save the FDA. Save FDA's medical officers from being fired. Got the rest of the industry to go along with this bill, used J and J's massive army of lobbyists to get Congress to pass it. And he was then being Investigated for criminal conduct around Risperdal. The company was in the midst of negotiation, negotiating a massive fine. And despite all that, he is not charged criminally. Fda, which was then investigating Johnson and Johnson's metal on metal hip implants, its vaginal mesh, instead of requiring that they be with withdrawn, they allowed Johnson and Johnson to just sort of stop selling them, which reduced hugely, Johnson and Johnson's liability for it. And then when Johnson and Johnson loses its first baby powder case in 2014, the FDA suddenly cooked up this statement saying that Johnson's baby powder is safe. They suddenly cooked up a statement saying Risperdal was safe in children. They suddenly cooked up a statement saying, you know, opioids are safe, like at each sort of place where Johnson and Johnson became vulnerable from a liability and courtroom perspective, suddenly FDA was there to endorse Johnson and Johnson's decisions and statements. So, you know, Johnson and Johnson basically bought and sold the fda. And the FDA has been saving Johnson and Johnson ever since.
- [62:42]
Kim Scott
So regulatory capture is certainly a big part of this. So obviously, the FDA should not be funded by Johnson and Johnson. It needs to be funded by the taxpayer.
- [62:53]
Gardner Harris
Exactly.
- [62:54]
Kim Scott
By. By public entities. How do people who are listening to this, how can they raise their voice and make that. I mean, do you write to your Congress? My congressperson, I may not be happy about it, but I'll do it. Like, what do we do? What do we do to like, raise awareness?
- [63:11]
Gardner Harris
Well, first, be careful yourself. Ask your own doctors if they're taking money from drug makers and device makers. The industry to this day gives American doctors directly somewhere between 2 and $3 billion in cash. That money clearly influences their decisions and often leads doctors to do dangerous things. And you need to. And by the way, you know, as a result of that moment in the airport at o', Hare, I did write a series of stories about antipsychotics in children. Those stories ended up spurring a Senate inquiry that then led to the Physician Payment Sunshine act, which is this website that you can find on CMS that if you put in your doctor's name, will tell you the payments they have gotten over the last five years from various drug makers.
- [64:03]
Kim Scott
So we'll drop a link to that in the show notes.
- [64:06]
Gardner Harris
Sure.
- [64:06]
Kim Scott
For people listening who want to check their documents.
- [64:08]
Gardner Harris
So go check that out. And I think you should, you know, even if it's a, if it's a good friend or something, you should tell your doctor, stop doing this. It's really a bad practice. And this is particularly true in orthopedic medicine. The amount of money that these orthopedists make from these schemes is just appalling, often in the millions of dollars. So that's another thing. And I think also, you know, I propose that when airplanes crash, the FAA is not asked to investigate because the FAA approved those planes to begin with. There's an independent group called the NTSB that investigates the National Transportation Safety board. I think FDA's culture is sort of lost. I think they have become so identified with the industry that that's where they are. I think we need to create a separate organization, somewhere between FDA and cms, that has oversight of already approved drugs and devices and tracks their safety. We have an enormous amount of information in the federal Medicare program that could be used to do active surveillance of drugs and devices and how they're operating. And we just don't do it because FDA doesn't want to hear it. It just doesn't. It's already approved these drugs, when they become disasters afterward, it's just bad news for them. And so medicines get approved, and even when they're shown to be dangerous, the FDA often does absolutely nothing about it. And that needs to stop.
- [65:38]
Kim Scott
Yeah. And it seems like Medicare, Medicaid, could be part of the solution because they have the data.
- [65:42]
Gardner Harris
That's the data, and it is shared. It is appalling. Appalling that those data are almost never used in these sort of surveillance efforts.
- [65:52]
Kim Scott
Yes.
- [65:52]
Amy Sandler
Well, one thing I'm really taking away from this is, you know, we might not feel like we can change a whole system, but we can do our own research, we can share our stories. I mean, I was really touched, Gardner, by you sharing your story about your son. So thank you for that and how those individual stories can take us out. There is so much institutional and emotional trust that we've given to this company and to these institutions. And I think just sharing our stories also seems like a really powerful way to start to make some change, both with our physician friends as well as our friends and neighbors. Kim, any last note before we close?
- [66:27]
Kim Scott
You can read the book. Buy the book. Buy the book. Read the book. It's a great book. And I mean, I certainly. It was. It's a big drink of water, but it is really also a powerful read. And by the end of it, I felt like I had more agency, more ability to do something about this, rather than less. So buy the book, read the book.
- [66:50]
Gardner Harris
At least it will give you some questions to ask when you're in the doctor's office or when you're there with your loved one in the hospital. Each one of these products is from a very different part of the healthcare system, and we all have dealings with each one of these parts of the healthcare system at some point in our lives. I'm hoping to empower you to at least ask the right questions.
- [67:13]
Kim Scott
Thank you so much for shedding light on all of this and for writing. I know writing a book like this is a labor of love, so thank you for doing it.
- [67:22]
Gardner Harris
All right, well, thanks for having me.
- [67:23]
Amy Sandler
Oh, thank you so much. So again, please do get Gardner's book no More Tears, the Dark Secrets of Johnson Johnson wherever you get your books. To see the show notes, you can go to radicalcander.com podcast. You also can watch this episode as a video on YouTube and Spotify. As we always say, praise in public, criticize in private. So please do rate and review us if you like what you hear, wherever you're listening. If you've got feedback for us, we suspect you might please do email us podcastradicalcandor.com Again, this information is empowering, so we encourage you to check out the book, to read it, to share it, and to keep asking those questions. Thank you so much Gardner. We're very grateful. Yeah the Radical Candor podcast is based on the book Radical the A Kick Ass Boss Without Losing youg Humanity by Kim Scott. Episodes are written and produced by Brandy Neal with script editing by me, Amy Sandler. The show features Radical Candor co founders Kim Scott and Jason Rosoph and is hosted by me still Amy Sandler. Nick Karisimi is our audio engineer. The Radical Caner podcast casting music was composed by Cliff Goldmacher. Follow us on LinkedIn Radical Candor the company and visit us@radicalcandor.com.