No More Tears: The Dark Secrets of Johnson & Johnson

By Gardiner Harris

No More Tears: The Dark Secrets of Johnson & Johnson

Hazard: A Mystery

Copyright © 2025 by Gardiner Harris

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Ebook ISBN 9780593229880

Cover design: Ben Denzer

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Contents

Introduction: A Quintessentially American Company

Part I

•

Consumer Products

Section I • Trust from Birth

Chapter 1 An Emotional Bond

Chapter 2 Three Brothers Go to New Brunswick, 1860–1968

Section II • Johnson’s Baby Powder

Chapter 3 Mineral Twins

Chapter 4 The FDA Conducts a Survey

Chapter 5 Birth of the Modern FDA

Chapter 6 The Power of Pressure

Chapter 7 A Meeting at a Harvard Hospital

Chapter 8 Secrecy Is a Top Priority

Chapter 9 A Sacred Cow

Section III • Tylenol

Chapter 10 An Infamous Crime, the Birth of a Myth

Chapter 11 Problems with the Narrative

Chapter 12 Never an Adversarial Relationship

Chapter 13 The Cost of Doing Business

Part II

•

Prescription Drugs

Chapter 14 A Valley of Death in Drug Discovery

Section IV • Procrit

Chapter 15 The First Great Biotech Franchise Is Born

Chapter 16 How Giving Cash to Doctors Became Good Business

Chapter 17 J & J’s Biggest-Selling Drug

Chapter 18 A Brave Researcher Breaks the Silence

Chapter 19 Miracle-Gro for Cancer

Section V • Risperdal

Chapter 20 A Path to a Normal Life

Chapter 21 A Treatment for Everything and Everyone

Chapter 22 Serious Red Flags

Chapter 23 A Big Target

Chapter 24 Ice Cream and Popcorn Parties

Chapter 25 A Turning Point

Chapter 26 One of the Most Alarming Warnings

Chapter 27 They Knew They Were a Good Company

Section VI • Duragesic

Chapter 28 An Epidemic Foretold

Chapter 29 Opium Blossoms in Tasmania

Chapter 30 Less Prone to Abuse

Chapter 31 Evolve the Value Discussion

Section VII • Ortho Evra Birth Control Patch

Chapter 32 The Pill and the Patch

Part III

•

Medical Devices

Chapter 33 The FDA Goes Looking for a Savior

Section VIII • Pinnacle Metal-on-Metal Hip Implant

Chapter 34 Two Terrible Dilemmas

Chapter 35 God, Nazis, and Hip Implants

Chapter 36 Never Stop Moving

Section IX • Prolift Vaginal Mesh

Chapter 37 A Cure for Sag

Chapter 38 Usually Minor and Well Manageable

Part IV

•

Vaccination

Section X • Covid

Chapter 39 A Rare Shot at Redemption

Acknowledgments

Notes

Index

About the Author

_150768685_

Introduction

A Quintessentially American Company

In late March 2004, I was returning from a spring skiing trip and had a couple of hours to kill at Chicago’s O’Hare Airport. Nothing in that cavernous place looked nearly as inviting as an open stool at a burger joint in front of a March Madness men’s college basketball game. I dropped my bag under the bar and sat down to watch.

Next to me was a woman wearing a maroon Mississippi State baseball cap with a blond ponytail pulled out the back. She had a beer and half a hamburger on the bar and didn’t seem to care that some of her fellow patrons might not appreciate her screaming at the TV in the middle of the afternoon.

The second half had just started, and Mississippi State had a commanding lead over Xavier, the tournament’s Cinderella story. We exchanged a few words during commercial breaks, but I’d spent most of the 1990s in Kentucky and knew enough rabid college basketball fans to know I should keep my trap shut while the game was on.

Keeping mum, I watched as Mississippi State collapsed. When the buzzer sounded, the woman with the ponytail groaned audibly, ordered another beer, and turned a rueful smile on me.

She told me her first name and said she was a pharmaceutical sales rep for Janssen, Johnson & Johnson’s biggest drug unit. I laughed and told her that I was a drug reporter for The New York Times.

She made a face, and I shrugged. You should probably leave right now, I said.

I was here first! she blurted and gave a terrific laugh.

We spoke about our lives and families in ways you only do with a stranger you’re all but certain never to see again. And then she told me a story that would drive my reporting for years.

She said her sister had a ten-year-old son who, a year earlier, had gotten into a fight on a school playground. The principal insisted the boy see a shrink. My bar mate’s job was selling Risperdal, a drug used to treat schizophrenia, so she offered to get her nephew an immediate appointment with one of her favorite psychiatrists, a specialist who would otherwise require months to see. Her sister gratefully accepted.

Convinced her nephew was perfectly normal, she expected the psychiatrist would admonish him not to fight again and then send him on his way. Instead, the doctor provided her sister with free samples of Risperdal—samples she had dropped off just days before. My bar mate was shocked and told her sister to think a minute before giving him that medicine.

But it was too late. Over the following year, her nephew gained twenty-five pounds and, embarrassed about his size, stopped visiting the neighborhood pool with his favorite aunt. My bar mate tried without success to persuade her sister to stop the medication. Her brother-in-law, who didn’t want the boy on Risperdal either, stopped speaking to her.

Around that time, word got out that the FDA would soon demand that every drug in Risperdal’s class of medicines carry new warnings noting that they could cause diabetes and other metabolic problems. Insisting this wasn’t true, Johnson & Johnson provided her with talking points to reassure doctors that Risperdal, unlike competing pills, didn’t increase the risks of diabetes. But watching her nephew, she knew those reassurances were false. Three weeks after our meeting, the FDA sent the company a warning letter stating that its claims about Risperdal and diabetes were false. A few months later, the company sent doctors across the country a letter admitting that it had mistakenly minimized the risk of diabetes and had made misleading claims that Risperdal was safer than similar drugs—confessions that came too late for many.

Before her nephew became one of the psychiatrist’s patients, she was thrilled that his Risperdal prescription numbers continued to climb and loved that his drug sample closet needed frequent restocking. He was one of her whales, a term drug sales reps use to describe doctors whose many prescriptions fund their bonuses. She’d showered him with gifts as recompense. J & J had paid him to give frequent marketing talks about Risperdal to other doctors, allowing him to build a robust referral network. Now the psychiatrist’s numbers made her sick, and she had a hard time even looking at him.

In fact, since Risperdal wasn’t approved by federal drug authorities for use in children, she’d been vaguely aware that parts of her job were a bit shady, including pitching Risperdal to child psychiatrists, dropping off drug samples to their offices, and paying these psychiatrists to tell other doctors how to prescribe Risperdal to children. But it hadn’t not been approved, so…

Now she suspected what she’d been doing was just plain wrong and told me she was about to quit. I asked for her last name and phone number and told her that, once she left J & J, she’d be the perfect source for a story about all this.

She shook her head. Can’t do that, she said in a southern drawl that had gotten thicker with her second beer. I’m only talking to you now ’cause I’m stuck in this dang airport, drank two beers, and the Bulldogs—God bless ’em—freakin’ lost. Seeded number two and they lost!

I sighed. First of all, let’s be clear about one thing, I said. The Bulldogs didn’t just lose, they got crushed. Had to be some kind of historic collapse. I mean, mother of God. Just painful to watch.

We both started laughing. I was never good at keeping a straight face when the moment demanded it.

Oh Lordy, she said and breathed deeply. And you think I’m going to talk to you now?

I slid my business card across the bar. Look, I said, you know this is an important story. How many other kids are out there just like your nephew? I can’t do this unless folks like you agree to talk.

Shaking that blond ponytail from side to side, she got up and gathered her luggage. She left my card untouched on the bar. "Take care of yourself, Mr. New York Times."

I never saw or heard from her again.

—

Eighteen years later, in February 2023, Fortune magazine ranked Johnson & Johnson among the most admired corporations in the world for the twenty-first consecutive year and ranked the company number one on the pharmaceutical industry list for the tenth consecutive year.

If there is a more American—quintessentially American—company than Johnson & Johnson, I do not know what it is, Tyler Mathisen, a longtime CNBC anchor, said at a network healthcare conference in May 2019. "And in fact, I can’t think of another company in the world with the possible, possible exception of Coca-Cola, that touches a billion people a day with its products and services as Johnson & Johnson does."

It’s true: Johnson & Johnson has been beloved for generations, and many Americans use its products daily. These have included Johnson’s Baby Shampoo, Johnson’s Baby Oil, and dozens of other baby lotions, conditioners, and sprays; Aveeno and Neutrogena skin moisturizers and cleansers; Tylenol and Motrin for headaches and fever; antihistamines Zyrtec and Benadryl; medicines like Pepcid, Sudafed, and Imodium; Listerine mouthwash and Nicorette gum.

Many of the company’s products are lifesavers, including medicines to treat HIV, cancer, and rheumatoid arthritis. Seven in ten patients globally who undergo surgery are stitched up with Johnson & Johnson sutures. J & J sells catheters and stents for the heart and implants for hips, knees, ankles, shoulders, and breasts.

Beyond its commercial success, Johnson & Johnson has long been seen as a paragon of ethics. First written in 1943, its credo—among the first and most prominent of corporate mission statements—promises that J & J will never put profits before people: We believe our first responsibility is, it begins, not to shareholders, not to owners, not the profit principle itself but to the patients, doctors, nurses, parents, and others who use Johnson & Johnson’s products and services.

Etched in stone at Johnson & Johnson’s New Brunswick, New Jersey, headquarters, the J & J credo is discussed at every major corporate meeting and consulted before significant strategic moves. When a maniac tested the credo in 1982 by packing Tylenol capsules with cyanide and killing at least seven people, Johnson & Johnson responded by withdrawing hundreds of millions of bottles from store shelves and relaunching with tamper-proof seals, an effort that cost $100 million.

A Harvard Business School case study of that episode has been used to teach thousands of executives in training that if they do the right thing even at considerable expense, customers will reward them—one of many Harvard case studies that collectively describe J & J as a capitalist’s nirvana where doing well and doing good are synonymous.

And it has done well. Johnson & Johnson is the largest healthcare conglomerate in the world, and one of only two corporations on the planet with a AAA credit rating, something not even the United States government can boast.

I spent my early teens in Princeton, New Jersey, where Johnson & Johnson is revered. Robert Wood Johnson II lived his final decades in Princeton, and his namesake foundation—the fifth largest charitable organization in the world—is headquartered there. The region is dotted with mansions owned by Johnson family members and top company executives who send their children to private academies like Princeton Day School and Lawrenceville.

To me, my family, and everyone I knew, Johnson & Johnson was the ideal American corporation. It was mother, medicine, and money all rolled into one. The kids I knew whose parents worked at J & J mentioned the association with pride, and the company’s distinctive red cursive logo was featured on T-shirts, jackets, and hats along the poolsides and sidelines of my swim meets and football games.

That image slowly began to change when I was assigned to cover the pharmaceutical industry in 1999 at The Wall Street Journal and then at The New York Times. My requests for even basic information were often unanswered. I was puzzled. What could Johnson & Johnson—of all companies—possibly have to hide? But bit by bit, I kept discovering things that transformed my confusion to disbelief. For example, I found that J & J was the only major manufacturer of HIV/AIDS medicines that refused to share its patents with a United Nations program that has saved millions of African lives. How was that possible? What about the credo?

Around the time of my encounter at O’Hare, I began to suspect that the company’s culture and its apple-pie image might be entirely at odds. But I couldn’t figure out when this change could have occurred, or why. And even as the company pleaded guilty to multiple crimes, paid huge fines, and was identified as a prime contributor to the nation’s opioid crisis, nothing seemed to dent its pristine reputation.

How could that be?

These questions haunted me for years. And though I moved off the healthcare beat and became a foreign, White House, and diplomatic correspondent for the Times, I kept thinking about J & J. Finally, my curiosity won out, and I turned again to the company that was simultaneously ever present and invisible. This book is the product of five years gathering tens of thousands of documents, reading through hundreds of thousands of pages of trial transcripts, and contacting hundreds of executives and employees. Among the records I uncovered are secret grand jury files. Providing such documents to a reporter is a criminal offense, but my sources put themselves at considerable risk because they found the company’s conduct so singular.

As a many-tentacled conglomerate, Johnson & Johnson’s history is exceedingly complicated and difficult to tell. Rather than bouncing between different products with their own discrete narratives inside one continuous chronology, I settled on recounting the separate histories of nine distinctive J & J products. The first section details the story of the company’s two most iconic consumer products—Johnson’s Baby Powder and Tylenol. The second looks at several important prescription medicines. The third tackles the company’s medical device business. The final section describes the path of the company’s Covid vaccine effort.

Johnson & Johnson is American healthcare’s central player, a colossus standing astride every part of a system that represents 20 percent of the nation’s gross domestic product, more than any other sector. Its story is the defining narrative of American healthcare and among the most important in all of American capitalism, but it has a very dark side. As we’ll see, its involvement with the rise of the opioid epidemic is horrifying. (The Sacklers are pikers compared to Johnson & Johnson, a former J & J executive told me.)

A crucial actor in this drama is the Food and Drug Administration, which has regulatory authority over that 20 percent of the American economy. Like Johnson & Johnson, the FDA has a reputation that is often at odds with its deeds.

The American media is also an important player. Much of what is written and broadcast about Johnson & Johnson and its partners is wrong. Because of my years working for them, The Wall Street Journal and The New York Times come in for particularly sharp censure. Their failings—and by extension my own—have been crucial to Johnson & Johnson’s mythmaking.

Perhaps most upsetting is that J & J could not have undertaken many of its most important and problematic sales efforts without the participation of doctors, researchers, academics, and educators. The American professional class is supposed to have independent self-policing mechanisms to ensure that its members don’t engage in unethical or criminal activity. J & J’s story offers significant reasons to be skeptical of the effectiveness of this self-policing infrastructure.

The vast disconnect between the mythology and reality of Johnson & Johnson should cast doubt on common fairy tales about the equity and rightness of the American systems of healthcare, government, and economy. Because CNBC’s Mathisen was right: J & J’s is the quintessential American story.

Part I

Consumer Products

Section 1: Trust from Birth

Chapter 1

An Emotional Bond

Johnson’s Baby Powder and Tylenol are among the most beloved and iconic consumer products ever sold. They largely define Johnson & Johnson’s image and have long provided the company with a protective halo of affection from consumers, professionals, and government officials.

While Tylenol is a juggernaut, Johnson’s Baby Powder is among the most potent branding instruments ever. The product’s fragrance resulted from a lengthy effort to concoct just the right bouquet. After multiple experiments, the company created a complex and distinctive floral scent with more than two hundred ingredients—natural oils, extracts, and aromatic compounds—from all over the world. The fragrance has a sweet, vanilla-like base but also contains overtones of jasmine, lilac, rose, musk, and citrus.

Company surveys found this distinctive mixture of ingredients to be the most recognized fragrance in the world, and for much of the American adult population it conjured the most pleasant memories and associations. Talc products were the cornerstone of the company’s baby products, which, despite sales that have in recent years represented less than 1 percent of the company’s revenues, were collectively the company’s most precious asset and crown jewel, according to a 2008 company slide deck titled Our Baby History.

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, the 2008 slide deck stated.

Surveys showed that the Johnson & Johnson brand is associated most strongly with baby products, and that this association creates an unmatched level of trust—invaluable for a healthcare company.

Many companies have rational trust, a 1999 corporate slide deck stated. It listed Merck, Bristol-Myers Squibb, GlaxoSmithKline, Procter & Gamble, and Colgate as among the companies with rational trust. At the time, pharmaceutical companies topped surveys of the most admired companies in the world. Only Johnson & Johnson also has real emotional trust.

Johnson & Johnson’s unique trust results in real business gains for the company, the presentation stated. Among the important benefits, the presentation claimed, is that consumers will forgive missteps and brand crises.

The most powerful of human emotional bonds is between a mother and her baby, the presentation stated. In the slides, the value of this bond is pictured as a piggy bank with coins dropping into its slot on the back, with the words Mother-Baby Bond on its side.

Johnson’s baby is 50% heart and 50% mind, concluded the slide deck, which is titled Trust Is Our Product.

A crucial way that Baby Powder engenders and sustains emotional trust is through its fragrance. Smells feed directly into the brain’s limbic system, the ancient seat of human emotion.

Olfactory learning occurs before birth and helps develop social capacities, another 2009 deck said. Infants attach meaning to familiar smells within first hours after birth and Odor is important in human mother-infant bonding.

So, for generations, much of the American population was implanted in the womb and throughout infancy with a brain worm that associates Johnson & Johnson with love, happiness, trust, and intimacy—a public relations contrivance of unrivaled power and perseverance. Those who attend graduate classes in business, communications, or medicine are still taught that Johnson & Johnson executives wrote the book on crisis response with their honesty and unselfishness in responding to an infamous Tylenol poisoning scare in 1982.

Internally, the positive associations with both products has been vital in creating and sustaining unusually strong beliefs amongst the company’s employees that J & J is uniquely ethical and an abiding force for good in the world, faith that paradoxically gives license to lapses that might not otherwise be accepted. Since the 1980s, every new J & J employee has been told soon after their hiring about the company’s response to the 1982 Tylenol poisoning case. The official story is repeated so often within the company that it has become something of a prayer.

Johnson’s Baby Powder and Tylenol have not contributed significantly to J & J’s profits in decades. But their histories remain the company’s defining narratives.

Chapter 2

Three Brothers Go to New Brunswick, 1860–1968

When the Civil War began, Sylvester and Frances Louisa Wood Johnson saw two of their eleven children immediately enlist in the Union Army. The next boy in line was Robert Wood Johnson, who was sixteen when the war started.

To protect Robert, his parents sent him from their home near Crystal Lake in northeastern Pennsylvania to Poughkeepsie, New York, to serve as an apprentice in an apothecary shop owned by his mother’s cousin, James G. Wood. Wood taught the young boy the laborious and mysterious art of medicinal plasters, an early combination of bandage, cast, and medicated patch made by cooking plaster and herbs such as mustard seed, belladonna, and capsaicin together, and then spreading the mixture over cloth and adhesive.

After finishing his apprenticeship in Poughkeepsie in 1864, Robert moved to New York City, where he took a job at a wholesale drug firm. Two years later he struck out on his own, setting up as a broker and importer of chemicals and drugs. He soon met George J. Seabury, another New York drug broker, who had dropped out of medical school to fight in the war. In 1873, the two men started Seabury & Johnson, renting three floors at 30 Platt Street in what is now New York City’s cavernous financial district to manufacture medicinal plasters and other products. The older of the two, Seabury served as the company’s president while Johnson took the titles of corporate secretary and sales manager.

In 1876, the two brought their plasters to the Centennial Exhibition in Philadelphia, the first official world’s fair in the United States, which lasted six months, attracting eight million visitors. Also displaying their wares that year was the German firm Paul Hartmann, which produced a line of antiseptic surgical dressings infused with creosote that had been popularized by Joseph Lister, an English surgeon whose success sterilizing surgical wounds had gained him international fame. In a vast and varied exhibition that featured the first look at Alexander Graham Bell’s telephone, the first typewriter, and the first electric lamp, Lister had top billing. At the closing banquet, he was seated at the right hand of President Ulysses S. Grant.

Johnson took careful notes on Hartmann’s products and attended Lister’s lecture at the fair. Finding himself among the believers in Lister’s findings, Johnson soon began experimenting with antiseptic postsurgical dressings. Lister’s products were tempting. The difficulties in manufacture of plasters, Johnson later explained, were that we could make plasters that would stick but wouldn’t keep, and we could make ones that would keep but wouldn’t stick. An 1879 Seabury & Johnson catalog had thirty pages of medicated plasters and also included Lister’s Antiseptic Gauze—a sign of things to come.

Around the time of the fair, Johnson brought Edward Mead Johnson, one of his younger brothers, into the business. Two years later, he offered a job to James Wood Johnson, another younger brother.

An inveterate tinkerer, James became intrigued with the challenges of plaster manufacturing. Hoping that rubber could solve both the stickiness and preservation issues, he created a machine to wash and crush crude rubber and another to grind, stretch, and roll it into thin sheets. These sheets were then coated with various medicines and sandwiched by protective cotton fabrics. These plasters, a yard wide and 120 yards in length, could be rolled onto spools from which hospitals and doctors could cut specific lengths for patients.

After expensive and time-consuming trials, James made what he, his brothers, and the wider medical community came to see as a true breakthrough: consistently achieving the right rubber consistency to make the plasters both effective and long-lasting. Sales surged, but as they did so, Johnson’s partnership with Seabury became strained. On July 18, 1885, not long after a contentious board meeting in which Seabury believed his partner was lying, Johnson resigned from the company, signed a ten-year noncompete agreement, and sold his shares to Seabury for $250,000, worth about $8 million today. His brothers resigned the same day.

Six months later, James Wood Johnson was on a westbound train going through New Jersey when he spotted a to let sign on a four-story red brick building in New Brunswick. He promptly disembarked and inspected the space, which was on the top floor of an abandoned wallpaper factory.

He and Edward Mead Johnson decided to get back into the medicinal plasters business. They rented the space, lured away fourteen employees—eight of them women—from Seabury & Johnson, and were off.

Robert’s noncompete agreement prevented him from joining his brothers. But Seabury soon missed some of his promised payments, and the two renegotiated their agreement. In exchange for canceling $120,000 in promissory notes, the noncompete was voided. On October 28, 1887, he took over his brothers’ nascent business, which had been incorporated as Johnson & Johnson. Robert got 40 percent of the shares and his brothers 30 percent each.

Over the course of the next months, two crucial things ensured the company’s success. First, Johnson retained the services of James Walter Thompson, who had just started a self-named advertising firm that would eventually become a global giant. The other was that Johnson met Dr. Fred B. Kilmer, the owner of the Opera House Pharmacy on Spring Street in New York City.

A folksy and engaging writer, Kilmer was widely respected in the pharmacy business. In 1888, he authored Modern Methods of Antiseptic Wound Treatment, a cross between a book and a catalog that included a listing of Johnson & Johnson products along with instructions about their use. The advertorial was a wild success and became a model for the company’s marketing efforts for decades in which engaging tutorials were paired with company products. The next year Kilmer sold his pharmacy and joined J & J as director of scientific affairs, a job he would hold for forty-five years.

Johnson & Johnson soon began mass-producing cotton and gauze bandages, constantly innovating new ways to clean, bleach (to sterilize), and comb cotton to produce soft, absorbent dressings. By 1894, the company had four hundred employees working in fourteen buildings, mostly along New Jersey’s Raritan River. Every morning, a steamship pulled up to a company dock to load four thousand pounds of cotton and fifteen thousand pounds of plaster dressings.

While the company’s supplies to doctors and hospitals formed the foundation of their business, Johnson and Kilmer had a knack for developing consumer spin-offs. One such creation was a small blue carton with a red cross on the label that contained absorbent cotton—a product that soon became one of the most recognized in the United States. Today, it’s almost impossible to imagine that simple sheets of cotton could be seen as so attractive to consumers. But up until then, they’d had to staunch cuts and wounds with whatever cloth they had around, no matter how dirty, or race to the doctor’s office or hospital.

In 1890, a doctor wrote Kilmer to report that one of his patients had complained of irritated skin after using one of the company’s medicated plasters. Some of the ingredients in the company’s plasters were known to have this effect, and Kilmer responded by sending the doctor a small tin of Italian talc, which he said would soothe the patient’s skin. The company soon decided to include small containers of talc with every order of certain plasters, and the powder became so popular that customers started asking just for talc refills. Some mothers reported that talc was an especially effective remedy for diaper rash.

Sensing an opportunity, in 1894 the company introduced Johnson’s Baby Powder, packaging it in a square metal container to prevent it from rolling away during diaper changes. The first toothpaste (called Zonweiss and soon sold in collapsible metal tubes inspired by those for paints) and smaller-sized consumer bandages followed, popular products in which Johnson & Johnson’s executives still take great pride.

Pfizer’s first big product was morphine. Merck’s early blockbuster was cocaine. Both companies conveniently tend to begin their corporate stories around World War II, when they became vital to the war effort by successfully ramping up production of penicillin. But Johnson & Johnson’s signature efforts to aid the country launched much earlier. After Congress declared war on Spain in 1898 following the mysterious explosion on the USS Maine in Havana harbor, Johnson & Johnson made and quickly delivered to the army and navy three hundred thousand packets of a newly developed compressed surgical dressing. When American troops landed in Cuba, they brought with them a new cloth stretcher that had been rapidly designed and manufactured at J & J—in the words of Fred Kilmer as told to reporters, Millions of pounds of cotton, millions of yards of gauze, miles upon miles of bandages, plasters enough to encircle the Earth. They are yours, Uncle Sam, if you need them.

Similar pledges were made two years later when a hurricane struck Galveston, Texas. In 1901, Kilmer authored a book with simple instructions and clear illustrations on bandaging and treating injuries. Johnson’s First Aid Manual was an instant hit and widely adopted in first-aid training programs around the country. When an earthquake leveled much of San Francisco in 1906, railroad cars filled with company products were moving toward the city within hours.

As the company moved into the twentieth century, business boomed. In 1911, J & J marked its twenty-fifth anniversary by touting the fact that it was producing 90 percent of the sterile cotton, gauze, and bandages sold in the world. A factory building near the railroad tracks linking New York City and Philadelphia sported a giant, iconic sign, 20 feet high and 102 feet across, of the Johnson & Johnson logo lit up in white lights with red crosses on either side. The company owned its own fleet of steamships. Its advertising campaigns highlighted its global reach with photos of Red Cross–branded products being carried by camel in India, hot-air balloon in Germany, and dogsled in the Arctic.

Robert Wood Johnson II was the oldest boy of his father’s four children and from his earliest days was the company’s heir apparent, often accompanying his father to business meetings. At the age of six, he was given a tuxedo with short pants so he could attend fancy social functions.

Raised largely by a governess, Robert attended Rutgers Prep, a private school a block from his palatial home in New Brunswick. Robert’s father decided to send his son away from home for his junior year in high school, and he was enrolled in the Lawrenceville School in Mercer County, one of the top private schools in the country. Unhappy, Robert ran away several times. Each time, he made his way to the Trenton, New Jersey, train station, where he waited to be picked up by his father or a member of the household staff. His father finally allowed him to return to Rutgers Prep, where he repeated his junior year.

Robert Wood Johnson II often spoke about his prep school years as wild, fun, and deeply educational. Robert’s wildness may have grown out of grief. In 1910, R. W. Johnson died of kidney failure. Soon after his father’s funeral, Robert’s mother moved to New York City with her two youngest children while Robert was left behind to live with his half sister and her husband.

Father died at the wrong time for Bob’s development, his sister Evangeline later said. He was just going into adolescence.

Since Robert Wood Johnson II was just sixteen at the time, R. W.’s younger brother James Johnson became the company’s president. That summer, Robert Wood Johnson II took a job at one of the company’s factories. When he graduated high school the next year, he decided that instead of attending college like so many of his friends, he would join the company full-time. His mother and his uncle, the company president, thought this a bad idea. A compromise was reached in which Johnson promised to attend postgraduate classes at Rutgers Prep while working part-time.

But Johnson soon began skipping classes and begging various foremen to hire him full-time. But with clear instructions from James Johnson that the young man was not allowed to work full-time, none would. Finally, the foreman of the power plant relented, and Robert Wood Johnson II started working there. He would later fondly recall his years working in the lowest rungs of the company’s operations but admitted that his drinking and late-night carousing got worse and started to seriously worry his uncle.

Finally, he reached a turning point—one that he recounted many times in his later years. Just before his twenty-first birthday, he arrived at the company offices blind drunk. He promptly passed out on the floor outside the room where the board of directors was meeting. The meeting over, the directors had to step over his body on their way out. Robert Wood Johnson II’s uncle was livid.

Uncle Jimmy told him that if he didn’t stop fooling around, he would sell the business, Walter Metts, Robert Wood Johnson II’s power plant boss, later recalled. He stopped that kind of behavior almost overnight and became a very serious-minded young man.

The transformation was so profound that Johnson was soon elected to the board of directors. Over the following years, Johnson was given more and more responsibility over a business that, with the outbreak of World War I, couldn’t keep up with demand. Factories began running twenty-four hours a day, seven days a week. Johnson & Johnson became the major supplier of medical products for Allied forces, and the company was soon launching new products and improving older ones based on discoveries made by army surgeons near the battlefield. Hundreds of temporary workers were hired, many of them women who saw working at J & J as a patriotic duty.

For the 1918 flu pandemic, J & J churned out millions more gauze masks, and millions more in profits. But by the summer of 1918, the company’s management team realized that, with the war nearing an end and the Spanish flu likely to peak soon, business as it had flourished would collapse. Consumer products, however, wouldn’t depend on crises, and the company’s Baby Powder seemed the most promising.

In 1918, Johnson & Johnson launched the largest advertising campaign in its history for Baby Powder. Hugely successful, it would forever link the J & J brand with proper infant care—so much so that a shelf of companion products followed. J & J began to refer to itself as the baby company, a moniker it would use through the first decades of the twenty-first century.

The next breakthrough came in 1920. After his wife kept cutting herself in the kitchen, a cotton mill employee created a long strip of surgical tape with gauze at intervals so she could quickly cut off a bandage to stem the blood. Thus was born J & J’s Band-Aid bandages—to this day the most trusted individual product brand in the world.

In addition to consumer products, Robert Wood Johnson II persuaded the company’s board of directors to let him and his younger brother take a seven-month trip around the now more settled world, a voyage that generated contacts and insights that would spur the company’s foreign expansion for years.

As Robert Wood Johnson II gained in confidence, his uncle began to recede from day-to-day management, and the company’s policies and operations began to reflect Johnson’s personal traits. At Rutgers Prep, he had delighted in being part of the school’s military drill team and became a punctilious dresser. As the corporate flag bearer for the antiseptic movement, the company had always insisted that its factory workers wear white uniforms that resembled those of hospital nurses and orderlies. But the young Johnson took cleanliness to another level, demanding that every corner and window of the company’s plants sparkle, office desktops always be free of paperwork, and executives dress sharply. His focus on appearance could be extreme; for example, he used a special scale to measure daily changes in his weight to within a fraction of an ounce.

Johnson was especially appalled at the sorry state of many industrial plants in the United States, particularly in the South, and he wanted to prove to the world that there was a better way. In 1926, as the beginning of Johnson’s Factories Can Be Beautiful effort, he commissioned a new and beautiful model of a textile-company village within Gainesville, Georgia. Next to a glistening single-story mill he built two hundred employee homes, a grade school, a medical facility, and several churches. Power lines were buried so as not to be visible, and the homes were among the first in northeastern Georgia to have indoor plumbing, electricity, and hot water.

Johnson eventually moved to a vast estate in Princeton but continued to commute to corporate headquarters in New Brunswick. The Route 1 corridor between the two towns became dotted with company plants that Johnson routinely visited to make sure they gleamed, varying his route so that no one could predict which plant he might inspect next. Sometimes he even appeared on Saturdays, surprising a few maintenance workers with a barrage of questions about operations.

Johnson insisted that factory floors and stairwells be painted white so dirt could not go undetected. Plant managers often received follow-up memorandums detailing myriad changes they needed to make, including trimming or replacing specific trees.

A disorderly plant is a symptom of confused management, he once wrote. I cannot look into a man’s mind, but I can look into his plant. Once, he drove by a plant and noticed that the building’s perfect symmetry was marred by a misaligned Venetian blind in one of its windows. He stopped, marched inside, and made sure the blind got straightened. During another inspection, Johnson spotted a dirty window over a stairwell landing and asked a foreman to have it cleaned. When he returned days later and found the window still dirty, he got a stick and carefully smashed out all of its panes. Perhaps, he reportedly said, now we will have a clean window.

Johnson decided early in his tenure that J & J would become a conglomerate of largely independent subsidiaries. Legend has it that he called a meeting to discuss problems bedeviling a new product and seventeen people showed up. I now know what the problem is, he told the assemblage. Too many people are involved. This meeting is over.

From that moment onward, he was a passionate advocate of decentralization, creating a conglomerate that became known as the Johnson & Johnson Family of Companies. When he expanded overseas, he did so by establishing separate companies operated by locals.

Johnson was as tough an auditor of ethical conduct as he was of dirty windows. Perhaps as a result, Johnson for decades resisted executives’ entreaties to enter the pharmaceutical business, which had long been tainted by hucksterism and poisoning scandals. In the 1950s, however, he finally relented, telling colleagues that he would agree to a drug acquisition if it was the right fit. In 1959, the team landed on McNeil Laboratories, a family-owned, Philadelphia-based drug firm founded in 1879 that specialized in sedation and muscle-relaxant drugs. Among McNeil’s most promising products was a prescription medicine for pain called Tylenol.

Just months after the McNeil acquisition, Johnson & Johnson purchased Janssen Pharmaceutica, a small drug development firm based in Belgium and run by Paul Janssen, who would prove to be one of history’s great medicinal chemists. While Janssen’s science was remarkable, the company lacked marketing and sales prowess, which Johnson & Johnson had in abundance.

Both the McNeil and Janssen purchases were spectacular successes. Two years after J & J bought McNeil, the FDA approved over-the-counter sales of Tylenol, and one of the greatest consumer franchises in history was born. Paul Janssen synthesized Haldol, which would become a huge-selling antipsychotic drug. And months before closing the deal with Johnson & Johnson, he developed a synthetic opioid that he would call fentanyl. Janssen eventually birthed seventy compounds that became commercial drugs, five of which were added to the World Health Organization’s list of essential drugs.

With astonishing speed, pharmaceuticals quickly became the company’s fastest-growing business. As J & J’s drug sales soared, Johnson named his son, Bobby Johnson, the company’s president. The bond between father and son was complicated and strained, in part because Johnson had divorced Bobby’s mother when Bobby was just eight. (Bobby told acquaintances that, in multiple instances, it was the family chauffeur who played what should have been his father’s role.)

Still, Bobby was eager to follow in his father’s professional footsteps and spent four summers working various jobs at the company. After he graduated from Millbrook School, an exclusive private school, Bobby attended Hamilton College for two years before joining the company as an hourly worker in the plaster mill, figuring his birthright was ultimately much more advantageous than a bachelor’s degree.

During World War II, Bobby enlisted in the army and served in Europe, rising to the rank of sergeant. When he returned, he got married, started having children, and quietly began to forge his own identity in the company. Pushing to make the company somewhat more democratic, he hired a series of hotshot marketing executives. At one point, Johnson suggested to his son that Bobby’s secretary wasn’t an appropriate guest in the executive dining room, but Bobby insisted otherwise.

It was just one of many examples of the father and his son’s inability to mesh. Rail thin and invariably well-dressed, Johnson couldn’t hide his disapproval of his son’s excessive weight and more casual outfits. In 1963, with his health beginning to fail him, Johnson appointed Philip B. Hoffmann, who had started at the company as a shipping clerk, to succeed him as chief executive and chairman, bypassing Bobby, who was appointed a co-vice-chairman of the company’s executive committee.

After being told of the new arrangement (Johnson instructed others to break the news), Bobby responded with a letter in which he wrote that while he disagreed with some of these changes, he pledged to remain loyal to his father and the company.

A year later, Johnson insisted that Bobby seek medical help for his excessive weight and other health problems. Bobby took a five-month