How Big Pharma Paved the Way for MAHA

The Atlantic

21-05-2025

In February, when Robert F. Kennedy Jr. was confirmed as the senior-most health-care official in the United States, many Americans were appalled. Kennedy has a long and lucrative history of promoting theories that are both unfounded (cellphones and Wi-Fi cause cancer) and dangerous (vaccines cause autism). If you're seeking explanations for the popularity of Kennedy and the so-called health-freedom movement, it might be tempting to turn to individual rather than systemic culprits: online influencers spreading conspiracies, politicians exploiting public anxiety, tech bosses engineering outrage and radicalization, grifters pushing pseudo-scientific miracle cures.
Some of these forces have likely helped Kennedy ascend to the top of the Department of Health and Human Services. But to attribute the mainstreaming of previously fringe beliefs solely to such people is incomplete. It promotes the comforting conclusion that Kennedy fans were simply duped and manipulated, and dismisses a possibility with more unsettling implications: that the status quo of health care in America left some people so disillusioned and distrustful that they were willing to try anything else.
As of 2023, health care makes up about 18 percent of U.S. GDP and accounts for roughly a quarter of all government spending—far more than in other similarly wealthy countries, but with generally inferior outcomes on most measures. Health-care companies have benefited from this state of affairs. Prominent among them is Johnson & Johnson, the approximately $370 billion institution that the investigative journalist Gardiner Harris describes in his meticulously reported new book, No More Tears, as 'American healthcare's central player, a colossus standing astride every part' of the industry. More than 135 years old, J&J has been trusted by millions who have used its skin-care products, relied on its over-the-counter remedies, and taken its medications for pain relief. The company manufactures a wide range of drugs and devices, including for cancer treatment and—at least for a time—COVID-19. (The last doses of J&J's COVID vaccine were pulled after they were found to increase the risk of blood clots in a very small percentage of users.)
The company was long heralded for its ethics, thanks in part to its 1982 decision to recall every bottle of Tylenol from store shelves in order to restock them with new tamper-proof containers, following the deaths of seven people who'd taken Tylenol that had been poisoned with cyanide. In its own telling, the company is guided by its ' credo,' a mission statement that 'challenges us to put the needs and well-being of the people we serve first.'
For generations, J&J was best known for Johnson's Baby Powder, a product that the company promoted as a symbol of its trustworthiness. 'The association of the Johnson's name with both the mother infant bond and mother's touch as she uses the baby products is known as Johnson & Johnson's Golden Egg,' a 2008 company presentation asserted. 'This association is one of the company's most precious assets.'
In No More Tears, Harris argues that the 'halo' from this 'Golden Egg' helped obscure a different side of Johnson & Johnson: a sprawling conglomerate that has acted brazenly, sometimes even illegally, in the pursuit of profit. In 2018, Reuters reported that J&J had known since at least 1957 that the talc in its baby powder contained asbestos. (The company denied the claim in full-page newspaper ads and on social media, tweeting, 'The FDA has tested Johnson's talc since the '70s. Every single time it did not contain asbestos.') Harris, who was previously a public-health and pharmaceutical reporter for The New York Times, cites a 1969 research paper on asbestos that found that 'it is difficult to conceive of a better way of having fibers inhaled than the use of cosmetic talcum powders.' By that point, scientists had proved that asbestos could cause cancer.
Rather than altering the formula of its baby powder, however, in the early 1970s, J&J and other members of an industry trade group developed a new test that was incapable of detecting trace amounts of tremolite asbestos—a version of the toxin that is particularly carcinogenic even in very small quantities—and did not even look for another type, chrysotile asbestos. Despite these shortcomings, the new test created the illusion of scientific credibility, allowing companies to plausibly claim that their products had been tested for asbestos. By the late '70s, Harris writes, the FDA (which was also using inadequate tests) was 'satisfied that the industry had finally and fully dealt with its asbestos problem.'
In the decades following, reams of research and billions of dollars' worth of court judgments found that Johnson's Baby Powder still contained asbestos. Tens of thousands of people have sued J&J, alleging that the company's talcum powder caused their mesothelioma or ovarian cancer. (Some juries have dismissed these claims, while others have not reached verdicts.) In a 2022 statement, the company asserted, 'We continue to stand behind the safety of Johnson's Baby Powder, which is safe, does not contain asbestos and does not cause cancer.' In 2023, the company stopped selling talc-based powder worldwide.
The story of Johnson's Baby Powder is one of nine case studies in No More Tears that follow a similar pattern: J&J developed medical devices, drugs, or other consumer products. It marketed them aggressively, sometimes despite knowing that they were ineffective or possibly harmful (and, in certain cases, for uses that were never approved by the FDA). Then, Harris writes, the company disputed or suppressed inconvenient findings, pushed misleading narratives, and, when necessary, spent large sums defending itself in court.
Consider the drug Procrit, J&J's synthetic brand of the protein erythropoietin (EPO), which is designed to increase the volume of oxygen-carrying red blood cells in the body. EPO was originally developed for kidney-dialysis patients; however, in the late '80s, the company began pushing Procrit for cancer patients weakened by their treatment, even as early research suggested that EPO might make heart attacks more likely and tumors more aggressive. In 1996, an ongoing trial on dialysis patients of another brand of EPO, by the pharmaceutical company Amgen, was stopped 'because patients receiving more EPO were dying in far greater numbers than those who got lower doses,' Harris writes.
Meanwhile, J&J was running a large-scale advertising campaign for Procrit, and sales were booming. In 2001, J&J began another trial of Procrit before terminating it prematurely when it found that patients who took it developed more blood clots than expected. Over the next few years, the company started and stopped at least five additional EPO studies for the same reason.
Despite the widespread evidence of very limited effectiveness and the risks of EPO drugs—even among many of the dialysis patients for whom they were originally intended—Procrit remains on the market today. Harris draws a parallel to the opioid crisis, in which regulators and pharmaceutical companies waited years before beginning to crack down on the sale of opioid-based painkillers.
Johnson & Johnson has also played a part in the opioid epidemic. Five years before Purdue Pharma received FDA approval to begin selling OxyContin, an oxycodone pill that Purdue claimed was less prone to abuse, J&J received the agency's sign-off on its own opioid-based painkiller. Duragesic was a fentanyl patch that was initially given primarily to cancer patients who struggled with swallowing—a relatively limited market. As Harris writes, doctors already knew that opioids were highly addictive; few of them 'were willing to prescribe them in anything but the most extreme circumstances.'
Harris reports that J&J deployed aggressive sales tactics and offered knowingly false assurances that Duragesic was less likely to be abused than other opioids. In fact, he notes, J&J had been making these arguments to doctors for years, even before Purdue began selling OxyContin, 'laying the groundwork' for the epidemic that followed. As Purdue began attracting national scrutiny in the early 2000s when the scale of the opioid crisis was emerging, J&J watched Duragesic sales surge. Harris attributes this growth in part to the fact that Purdue and OxyContin attracted much of the public's outrage and fear, which helped J&J sell its own drug.
'I believe Johnson & Johnson was a major cause of our opioid crisis,' Andrew Kolodny, an opioid expert at Brandeis University, testified in an ultimately unsuccessful 2019 lawsuit filed by Oklahoma's attorney general. (In a separate action by a coalition of state attorneys general, J&J agreed, along with three pharmaceutical distributors, to pay a settlement of $26 billion.) Owing in part to the fact that J&J actually owned poppy fields that grew the opiate, which the company used in its products and also sold to other manufacturers, including Purdue, Kolodny called J&J 'the kingpin in our opioid crisis.'
J&J has had few better friends than its regulator: the FDA. Harris's condemnation of the agency is relentless; he details the ways he believes it's been captured by the industry it should be overseeing. In 1992, Congress passed a law shifting a large portion of the agency's funding source from taxpayers to health-care companies, leaving the FDA, as Harris puts it, 'financially dependent on the drug industry.' In 2011, J&J swooped in to coordinate new industry funding for the FDA, which preserved hundreds of agency jobs. Meanwhile, the revolving door between regulators and the companies they are supposed to monitor spins freely under both Democratic and Republican administrations.
A similarly searing critique of the FDA echoes throughout another recent book. The science journalist Charles Piller's Doctored details the yearslong dominance of a strain of Alzheimer's research that has turned out to be less promising than its reputation would suggest. The 'amyloid cascade hypothesis,' so named in a landmark 1992 paper published in Science, proposes that the accumulation in the brain of a protein called amyloid-beta causes Alzheimer's disease. For decades, the majority of Alzheimer's research has centered on this hypothesis, Piller writes, drawing billions of dollars in funding, enrolling thousands of patients in amyloid-related drug trials, and preventing other theories from gaining traction.
It turns out, however, that some of the foundational research linking amyloid buildup to Alzheimer's relies on possibly fraudulent work. A central thread of Doctored is the story of Matthew Schrag, a Vanderbilt University neuroscientist who in 2021 began collecting indications that the research supporting simufilam, a new Alzheimer's drug developed by the biotech start-up Cassava Sciences, was based in part on manipulated images.
Schrag's work helped spark a chain of events that led to the termination of the drug's clinical trials last November. But his discovery also drove him to look more closely at other Alzheimer's research. Eventually, he and other researchers found hundreds of studies—including many that have served as the basis for human clinical trials—that appear to include images or data that were, as the book's title suggests, allegedly doctored by researchers. These studies have been cited tens of thousands of times in scientific papers. (Two researchers who Piller says manipulated images settled a suit with the Securities and Exchange Commission last year without admitting or denying guilt. They did not respond to requests for comment from Piller for his book.)
Despite these revelations, the larger amyloid hypothesis has not been discredited. Although there seems to be a link between amyloid proteins and Alzheimer's, whether the relationship is causal or correlational isn't clear. Amyloid-related treatments have been effective at moderately slowing the progression of the disease in some early-stage Alzheimer's patients, but Doctored makes a strong argument that scientists, universities, patient groups, and pharmaceutical companies have advocated for this treatment beyond what the evidence merits, and instead of exploring other promising avenues. (Last year, the FDA approved a new anti-amyloid drug called Kisunla.)
Piller's investigation vividly captures the risks borne by whistleblowers like Schrag, not just for calling out apparent fraud but also for challenging conventional wisdom. Yet in an era of rising distrust in experts, Schrag and his fellow scientists face a broader conundrum. In Doctored, Piller considers whether overly publicizing scientific misconduct without offering solutions 'creates a risk of people throwing up their hands and thinking 'the whole scientific enterprise is a cesspool of corruption,'' as a friend worries to him.
The risk of adding fodder to public cynicism is a real concern. But is it possible to restore trust in science and public health without first accepting that, in many cases, that trust has been lost for understandable reasons? To witness how Johnson & Johnson has pushed expensive and sometimes dangerous products is to understand why people might feel so betrayed by the health-care establishment that they'd roll the dice on a vaccine skeptic and conspiracy theorist. To discover that billions of dollars in Alzheimer's funding, and numerous clinical trials that recruited vulnerable human beings and their families, could have been based on fraudulent research is to see that Americans are right to be angry. Long before Donald Trump and DOGE and RFK Jr. came for scientists and health-care workers, too much of their work was already being undermined by a system that prioritized profit over care.
Together, Doctored and No More Tears offer a sweeping indictment of the status quo. Neither the actions of companies such as Johnson & Johnson nor their influence over regulators and politicians created a movement like ' Make America healthy again.' But they helped create space for it. In their relentless pursuit of profit, they helped break the faith that held dangerous alternatives at bay.
The journey to undo the damage and restore trust is a difficult and uncertain one. A good starting point might be to consider why people are so angry and distrustful, rather than blaming them for losing faith in a system that has made money off their pain for far too long.