No More Tears: The Dark Secrets of Johnson & Johnson

No More Tears: The Dark Secrets of Johnson & Johnson (2025) by New York Times investigative reporter Gardiner Harris is an exposé of medical conglomerate Johnson & Johnson’s unethical and illegal business practices over the decades, from hiding evidence of asbestos contamination in their talc-based baby powder to lack of quality controls in its development of a Covid-19 vaccine. Harris describes how thousands of Johnson & Johnson costumers and patients have been harmed by consumer products, prescription drugs, and medical devices sold by Johnson & Johnson in their pursuit of profits at any cost.

Gardiner Harris is an award-winning investigative reporter. Early in his career, he reported on efforts by mining companies and the state government in Kentucky in the 1990s to cover up the carcinogenic effects of poor air quality in coal mines. Over the years, he has reported for the Wall Street Journal and The New York Times across a variety of beats including pharmaceutical companies, the White House, foreign policy, and public health. No More Tears is his first nonfiction book.

This guide uses the 2025 Penguin Random House Kindle e-book edition of No More Tears.

Content Warning: The source material and guide feature depictions of mental illness, physical illness, graphic descriptions of surgical and medical side effects, anti-Black racism, drug dependency, and death. No More Tears briefly references death by suicide.

Summary

No More Tears is broken into four parts, covering public health crises around nine different products produced and sold by Johnson & Johnson and its subsidiaries: Johnson’s Baby Powder, Tylenol, Procrit, Risperdal, Duragesic, Ortho Evra, the Pinnacle metal-on-metal hip implants, Prolift vaginal mesh, and the Johnson & Johnson Covid-19 vaccine.

In Part 1, author Gardiner Harris covers the two consumer products that are so central to Johnson & Johnson’s overwhelmingly positive public image historically: Johnson’s Baby Powder and Tylenol. Johnson’s Baby Powder is a product that was first introduced in 1894. It was made out of ground talc, a fine mineral powder, and was used to soothe skin rashes, including diaper rash. Johnson & Johnson was aware that its talc powder was contaminated with asbestos, a highly carcinogenic mineral that causes cancers like mesothelioma. However, it sought to hide or minimize this knowledge from the Food and Drug Administration (FDA) for decades. As a result, thousands of people, particularly women, got asbestos-related illnesses. 

Harris criticizes both Johnson & Johnson and the FDA’s role in this crisis. He argues that the FDA provided cover for Johnson’s Baby Powder in part because the FDA is reliant on fees paid by medical companies, including Johnson & Johnson, for its operating budget. In 2018, attorney Mark Lanier won the first multi-party civil case against Johnson & Johnson for its role in knowingly selling asbestos-contaminated baby powder. In 2023, the product was finally discontinued worldwide. Hundreds of similar cases are still pending as of 2025.

Harris then discusses controversies around Johnson & Johnson’s over-the-counter pain medication, Tylenol. Tylenol is the best-selling over-the-counter pain medication in the United States. Harris’s analysis of Tylenol is broken into two parts. First, Harris analyzes Johnson & Johnson’s potential liability for its role in the 1982 Tylenol poisoning case. In 1982, multiple bottles of Tylenol in the Chicago metropolitan area were poisoned with cyanide, leading to the deaths of at least seven people. The case was never officially solved. 

Harris alleges that a disgruntled rack jobber, or person who works stocking a company’s product on grocery and pharmacy shelves, named Roger Arnold is responsible for the poisonings. Harris argues that since Arnold worked at a warehouse that stored wholesale Tylenol, Johnson & Johnson bears some responsibility for the crisis because it occurred within their supply chain. Harris criticizes the mainstream narrative that Johnson & Johnson acted swiftly to resolve the crisis by noting it took them several days to issue a nationwide recall of Tylenol. Next, Harris discusses Johnson & Johnson’s minimizing of evidence that Tylenol has a very narrow “margin of safety,” meaning that it is relatively easy to accidentally overdose on its active ingredient acetaminophen, which causes liver disease. This issue is particularly acute in moderate drinkers.

In Part 2, Harris covers controversies around four of Johnson & Johnson’s prescription medications: Procrit, Risperdal, Duragesic, and the Ortho Evra Birth Control Patch. Procrit is a prescription medication that stimulates red blood cell growth for the treatment of anemia. Harris argues that Johnson & Johnson hid studies that showed use of Procrit led to negative outcomes, particularly for cancer patients, as it led to the growth of cancerous tumors. Johnson & Johnson was also found liable for engaging in Medicare fraud in encouraging the prescription of this drug; it would provide Procrit to providers for low or no cost while asking the government for reimbursements for the full listed cost of the drug.

Risperdal is an antipsychotic medication used in the treatment of bipolar disorder and schizophrenia that Johnson & Johnson claimed had fewer side effects than its older antipsychotic, Haldol. Harris describes how Johnson & Johnson illegally marketed the use of Risperdal to elderly patients with dementia and young patients with behavior disorders and depression. In elderly patients, Risperdal led to strokes, heart attacks, and even death. In younger patients, it led to metabolic disorders including diabetes and gynecomastia, or breast tissue growth. Johnson & Johnson attempted to hide the extent of these side effects until the FDA forced it to roll back its marketing to these populations.

Duragesic was a synthetic fentanyl patch used for the long-term treatment of severe pain. Johnson & Johnson marketed Duragesic as a less-addictive alternative to Purdue Pharma’s opioid OxyContin, despite evidence that fentanyl is just as addictive. Harris also examines Johnson & Johnson’s key role in developing and selling the active opioid ingredient of OxyContin to Purdue Pharma. Harris claims that Johnson & Johnson has an unacknowledged role in the ongoing opioid crisis in the United States.

Ortho Evra is a hormonal contraceptive birth control patch. The patch delivers inconsistent levels of the hormone estrogen, leading to higher-than-average estrogen doses which can lead to blood clots and strokes. In some instances, the patch does not deliver enough estrogen, leading to pregnancy. Harris criticizes Johnson & Johnson for hiding the unfavorable results of its Ortho Evra clinical trials from the FDA.

In Part 3, Harris covers controversies around two of Johnson & Johnson’s medical devices: The Pinnacle metal-on-metal hip implant and Prolift vaginal mesh. Typically, hip implants are made from metal-on-plastic, as metal-on-metal wear and tear can lead to metal shards coming dislodged from the implant, embedding in muscle tissue, and causing implant failure. The day before Johnson & Johnson sent its plans for a metal-on-metal implant to the FDA, an engineer reported one of its implants in a simulator had failed. Johnson & Johnson sent the original plans to the FDA for approval while changing the design without informing the regulatory agency. It hid reports of “adverse events,” or implant failure, from the agency. Gradually, knowledge of the failures of the implant became widespread among orthopedic surgeons and it was eventually taken off the market.

Prolift vaginal mesh was a plastic mesh that was inserted vaginally to help prevent the bladder from pressing against the vagina, causing incontinence and prolapse. Although the medical team that contributed to its design raised concerns with the company about issues with the product, Johnson & Johnson put it on the market without asking for FDA approval. Over time, it became clear that the mesh would erode through thin vaginal walls causing terrible complications, including pain during sex. Many women had to have corrective surgery to remove the mesh. In the face of rising concerns, Johnson & Johnson pulled Prolift and other vaginal meshes from the market in 2012 and the FDA banned them entirely in 2019.

In Part 4, Harris describes Johnson & Johnson’s efforts to develop a Covid-19 vaccine. Although they had not historically developed vaccines, they wanted to do so in order to improve their public image following the backlash from the revelations about asbestos contamination in their baby powder. Johnson & Johnson worked with respected virologist Dr. Dan Barouch of Harvard to create an adenovirus-based Covid-19 vaccine. Unlike mRNA vaccines, the adenovirus vaccine did not need to be refrigerated and only one shot was required. Johnson & Johnson partnered with Emergent BioSolutions to manufacture the vaccines at scale. However, Emergent’s Baltimore facility had issues of contamination, leading to thousands of vaccine doses having to be discarded. Further, it was found that the Johnson & Johnson vaccine could cause serious blood clots and Guillain-Barré syndrome. This fueled vaccine skepticism. In 2023, the FDA revoked authorization for the Johnson & Johnson Covid-19 vaccine.

Harris concludes with a list of reforms he thinks can address some of the problems he identified in No More Tears. Chief among them, he argues, is that oversight and regulatory structures need to be strengthened within the company, in government, and in the medical science domain to ensure that Johnson & Johnson operates ethically and legally. He laments the thousands of people who have been harmed over the decades by Johnson & Johnson’s products.