PDF Summary:No More Tears, by Gardiner Harris

If you’ve ever taken Tylenol for a headache or powdered a baby’s bottom with Johnson’s Baby Powder, journalist Gardiner Harris has some bad news for you. In No More Tears (2025), he exposes how pharmaceutical giant Johnson & Johnson (J&J) knowingly deceived its customers over decades, causing them to rely on unsafe or actively harmful products. Harris uses internal J&J company records, legal documents, and scientific research to show how an industry that’s supposed to care for consumers’ health and well-being is driven by profit to do the opposite. Simultaneously, he reveals how the industry’s watchdogs cover for its crimes.

Our guide explores some of Harris's key discoveries, including how J&J deceived its customers and impacted their health through three key products: Johnson’s Baby Powder, Tylenol, and Duragesic. We supplement Harris’s findings with additional context about the broader systems that enable companies—both within and beyond the pharmaceutical industry—to put customers at risk.

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(Shortform note: Marketing theory supports Harris’ claim that Johnson’s Baby Powder may owe its success to its evocative branding. This exemplifies a brand halo strategy, where one product’s positive associations radiate outward to benefit other company offerings. J&J’s specific technique—using fragrance to trigger emotional responses—is known as sensory branding. This approach leverages the direct brain connection between smell and the limbic system—the brain’s emotional center—to bypass rational decision-making and create visceral brand loyalty that extends across the entire product portfolio.)

The Lie: Asbestos-Free Talc

While Johnson’s Baby Powder projected an image of purity and care, J&J covered up mounting evidence of harm resulting from its use. Harris argues J&J knew from internal testing dating back to 1958 that its talc contained asbestos, which are harmful fibrous minerals.

(Shortform note: J&J’s talc problems went beyond Baby Powder. An investigation found that a 1972 lab note clearly identified asbestos in a sample of J&J’s Shower to Shower, a talc product for adults that has also been linked to ovarian cancer. However, the company didn’t submit that note to the FDA when the agency tried to ascertain whether their products were safe.)

By the 1960s, scientific literature was establishing clear links between asbestos and cancer, yet J&J continued to claim the product was safe. During the 1970s, scientists found that talc—even when it wasn’t contaminated with asbestos—could also cause cancer.

(Shortform note: In The Cancer Code, Jason Fung writes that cancer is almost always the result of carcinogens, which are environmental factors that damage or destroy cells. Thus, asbestos and talc can be considered carcinogens alongside other widely recognized carcinogenic substances like tobacco and radiation.)

Harris explains that instead of changing the powder’s components, J&J added minimal warnings on the packaging that failed to convey the true risk. The company only stopped selling talc-based Johnson’s Baby Powder in the US and Canada in 2020. J&J announced it would cease global sales in 2023, more than 60 years after it first learned its product was dangerous to consumers.

(Shortform note: Besides failing to warn consumers about the risks of their product, J&J actively marketed it to specific demographics to compensate for declining sales. J&J focused its Baby Powder marketing on women of color and overweight women. For example, it distributed samples in minority neighborhoods and ran campaigns with plus-size brands. As consumers became aware of these practices, they put pressure on the company. In 2020, after J&J released a statement in favor of the Black Lives Matter movement, Black-led organizations denounced the company’s hypocrisy as it continued to sell its product to women of color around the world while acknowledging it wasn’t safe for US consumers.)

Harris outlines several strategies J&J used to keep their baby powder on the market, including:

• Manipulating research. J&J created a talc testing method purposely designed to miss asbestos contamination and forced employees to remove mentions of asbestos from laboratory notebooks.
• Manipulating the FDA. J&J refused to share talc test results with the FDA and lobbied against the stringent testing standards the agency tried to enforce. Still, the FDA helped J&J by claiming, with no evidence, that it was possible to source asbestos-free talc.

(Shortform note: The strategies Harris describes—manipulating testing methods, suppressing internal evidence, and lobbying against regulation—continue to obstruct asbestos oversight today. For example, despite the 2022 Cosmetics Modernization Act requiring talc testing in cosmetics, the US government withdrew the rule after industry pushed back, with the FDA citing “unintended consequences” for manufacturers.)

The Impact: Cancer

J&J’s lies about Johnson’s Baby Powder affected millions of users. Babies and their mothers inhaled thousands of cancer-causing particles every day for years, sometimes leading to mesothelioma (a rare type of cancer linked to asbestos). In addition, Johnson’s Baby Powder was a popular personal care product for women, who used it in their genital area. Harris explains that, by some estimates, Johnson’s Baby Powder contributed to around 2,500 women being diagnosed with ovarian cancer annually in the US.

(Shortform note: The impact isn’t limited to the US. For example, in the UK, more than 3,000 people sued J&J in 2025, arguing that its Baby Powder triggered their cancer. Some of the largest sums awarded by juries to victims of J&J are for mesothelioma sufferers. However, ovarian cancer is much more common, and the more recent legal victories of women who blame J&J for their ovarian cancer have opened up the company to broader liability.)

Harmful Product #2: Tylenol

Tylenol is an over-the-counter pain reliever used to treat headaches, colds, fever, and other minor aches and pains. Its main component is acetaminophen. Tylenol appeared to have no adverse effects on the stomach or heart, unlike other pain medications. This became Tylenol’s primary selling point during the 1970s, when ulcers and gastritis were widespread health issues. By the early 1980s, Tylenol had become the most widely used pain reliever in the US.

(Shortform note: Recent research has called into question Tylenol’s relative safety compared to other pain medications. For instance, a 2024 study from the University of Nottingham found that acetaminophen use in older adults (65 and older) is linked to increased risks of peptic ulcers, gastrointestinal bleeding, heart failure, hypertension, and chronic renal failure.)

The Lie: Safe Pain Relief

Despite its promising start, danger was lurking in Tylenol. The company used slogans like “the pain reliever hospitals use most” to suggest medical endorsement and assure consumers that Tylenol was safe. However, the drug had an extremely narrow safety margin.

(Shortform note: Other authors point out that J&J’s slogans highlighted the trust consumers placed in their doctors and hospitals without stating outright that Tylenol was safe. For example, another famous slogan said “Trust TYLENOL. Hospitals do.” The implication was that Tylenol was safe, since hospitals trusted it, but J&J’s marketing didn’t say as much.)

By the mid-1970s, several medical studies had demonstrated that Tylenol caused serious liver toxicity issues. Minor dosage errors could lead to fatal liver damage, including taking slightly more than recommended, combining it with other products containing acetaminophen, or drinking alcohol with Tylenol still in your system.

In addition, Harris says that Tylenol’s confusing product lineup and labeling led to fatal dosing errors. For example, J&J sold pediatric acetaminophen in different concentrations: a concentrated one for babies and another for older children. The formula for babies was more concentrated—parents could give them fewer drops—to make the process of giving a baby medicine a bit easier. However, the different formulations were both labeled for pediatric use, which confused parents, and even nurses and pediatricians. For example, if an older child was prescribed 10 drops of children’s Tylenol, and a parent or doctor gave them 10 drops of infant Tylenol, this could cause a fatal overdose.

(Shortform note: The problems with pediatric over-the-counter medicine seem to go beyond J&J. A 2009 study of how parents read and interpret children’s cold medicine found that caregivers frequently misunderstand instructions on pediatric medicine’s labels. Although the FDA doesn’t recommend the use of cough and cold medicine in children under two, many of the products available on the market have the word “infant” on the label. This leads parents to assume that the medicine is safe and recommended for very young children. In addition, the study found that many parents had a numeracy level at or below the 9th grade. This correlated with mistakes when making dosage decisions. As in the case with Tylenol, small dosage mistakes could be potentially life-threatening, especially for small children.)

Despite mounting evidence of Tylenol’s risks, J&J continued to market the drug as safe. The FDA and several medical associations requested J&J add warnings to its labels, so consumers would know to take precautions. However, J&J believed that the warnings would cause people to take less Tylenol, so they fought off the requests for decades.

(Shortform note: While Tylenol is sold over the counter with no warnings, prescription medications containing acetaminophen have an FDA-mandated warning label. The label states that overdosing can lead to liver damage requiring a transplant or even result in death. In addition to label warnings, J&J fought a public health education initiative by the US government. Journalists concluded that the company believed a more informed public would result in fewer Tylenol sales, so J&J prevented the initiative from being implemented.)

While continuing to market Tylenol as safe, J&J ran a secret research program to develop a safer version. Harris explains that they later abandoned the program because executives worried that launching an improved product would acknowledge the existing one wasn’t as safe as they had claimed.

(Shortform note: Although it failed to create a safer acetaminophen, J&J did contribute to the development of an antidote for acetaminophen overdoses, which has helped patients recover from near-fatal overdoses.)

The Impact: Liver Failure and Accidental Overdoses

Harris explains that by 2013, acetaminophen had become the leading cause of acute liver failure in the US, killing at least 150 people annually and hospitalizing 30,000.

(Shortform note: The incidence of acetaminophen-related health problems may be rising. A 2017 study found that the US recorded around 500 yearly fatalities and over 50,000 hospitalizations resulting from acetaminophen use. To help you navigate the risks of acetaminophen, bookmark the resources on this page.)

Harris adds that children were also vulnerable to acetaminophen-related deaths. Between 2000 and 2009, the FDA received reports of 20 children dying from acetaminophen overdoses.

(Shortform note: Researchers have also examined possible links between prenatal acetaminophen exposure and children’s brain development. A 2021 study found that children exposed to acetaminophen before birth were 19-21% more likely to be diagnosed with Autism Spectrum Conditions (ASC) and ADHD—two common forms of neurodivergence. However, this correlation might be related to the underlying illness that led the mother to take the medication. A 2019 study found that pregnant women who had a fever during their second trimester were more likely to have children diagnosed with ASC. Since acetaminophen is commonly used for fevers, the autism link may have more to do with why the mothers took the medication than what medication they took.)

Harmful Product #3: Duragesic

Duragesic is an opioid patch designed to provide steady pain relief over 72 hours. The patch contains fentanyl, an addictive, synthetic opioid 75 times more powerful than morphine. The patch uses a timed-release technology, where a reservoir of fentanyl is gradually absorbed through the skin, theoretically offering stable and prolonged pain control. The product was originally intended for cancer patients who had difficulty swallowing oral pain relief medications, but J&J started marketing it for chronic pain conditions, like arthritis. According to Harris, this pivot was profitable because chronic pain patients could become repeat customers, unlike those with terminal cancer.

(Shortform note: J&J's expansion of Duragesic from terminal cancer patients to chronic pain sufferers illustrates a standard marketing principle. In How Brands Grow, Byron Sharp explains that successful brands operate in mass markets rather than narrow niches, and companies achieve greater profits by broadening their customer base. However, J&J's application shows how this strategy can become problematic when the product carries risks. While expanding their market maximized revenue through repeat purchases, it also exposed far more people to fentanyl’s addiction risks.)

The Lie: A Safer Opioid

Harris states that J&J falsely promoted Duragesic as a safe alternative to other opioids. The positioning of the fentanyl patch as safe was based on two lies:

Lie #1: Duragesic’s timed-release technology was overdose-proof. In reality, the controlled-release system was unreliable. It often delivered 150% of the intended dose in 24 hours, causing overdoses even with proper use. What’s more, people with an opioid addiction could easily bypass the system by chewing the patch to release the full dose instantly, which was often fatal.

(Shortform note: In addition to being unreliable and easy to bypass, the patch technology also presents other risks. For instance, when patients are exposed to heat, such as heating pads or hot baths, the patch releases more of the opioid, often leading to overdose or death.)

Lie #2: Duragesic was less addictive than other opioids. Abuse rates seemed lower than they were because hospital urine tests couldn’t detect fentanyl. J&J sales representatives used this flawed data, telling doctors that their patch caused less than 1% of ER visits, while knowing it was impossible to know how many people overdosed on Duragesic.

(Shortform note: As of 2024, Fentanyl was still difficult to detect in hospital screenings. Standard drug screens don’t include fentanyl, as it’s a synthetic opioid with a different molecular structure. While hospitals can add fentanyl testing to their panels, most haven’t due to the additional cost. However, there are other ways to assess the extent of fentanyl addiction, such as by closely monitoring dosing data. A 2025 study from South Korea analyzed fentanyl transdermal patch (FTD) use over seven years among noncancer patients. Over that time, the number of patients prescribed FTDs decreased, but total dosing increased by 7.4%. The higher consumption despite fewer patients suggests that some patients were using FTDs inappropriately.)

Despite these lies, J&J successfully established Duragesic in the opioid market. Harris outlines several strategies J&J used to increase sales of their patch, including:

• Manufacturing consensus: J&J funded patient groups and medical societies, with whom they coauthored statements endorsing opioids for long-term pain management. J&J then distributed these materials to encourage doctors to prescribe opioids.
• Exploiting patients’ pain: J&J’s sales teams targeted doctors treating high-risk patients and encouraged longer treatments to boost sales. J&J rewarded top prescribers, even if the number of prescriptions the doctors made suggested they were catering to addicts.

(Shortform note: It seems that J&J isn’t alone in using these strategies to establish their products in the market. Investigators in Europe found that patient groups are almost entirely funded by pharmaceutical companies, with J&J being one of the top donors. The investigators warned that patient organizations end up serving as marketing channels for drugmakers, promoting new medicines despite controversies over efficacy and dependency risks, and lobbying for governments or insurance companies to cover their costs. In addition, other pharmaceutical companies in the opioids market, such as Insys, have been found to exploit patients’ pain by bribing doctors to prescribe drugs to patients.)

In a landmark case against J&J, the state of Oklahoma successfully argued that the company targeted vulnerable patients such as veterans and children to boost sales. During that trial, it also emerged that J&J salespeople encouraged doctors to ignore their suspicions that patients were addicted if they asked for a higher dose, and trust that they were truly in more pain than they could manage. This likely contributed to patients—including addicts—getting higher and longer prescriptions than they otherwise would have.

The Impact: Normalizing Addiction

Harris argues that J&J stoked the opioid epidemic in several ways—we’ll focus on describing two of these. First, Duragesic’s marketing normalized long-term opioid use and overprescription. J&J’s misleading safety claims led doctors to prescribe the patch to more patients, worsening opioid misuse and overdose deaths.

Second, J&J’s involvement spanned the entire supply chain. In addition to producing their own products, they grew opium poppies in Tasmania through their subsidiary and sold the raw material for opioids to other pharmaceutical companies, such as Purdue Pharma.

(Shortform: According to experts, J&J, Purdue, and other opioid manufacturers engaged in unbranded promotion. This meant promoting opioids more broadly without necessarily directing doctors to their specific brands. Along with authoring statements and scientific literature promoting the use of opioids, unbranded promotion helped normalize long-term opioid use and the frequent prescription of opioids, since the first hurdle in selling their products was getting doctors comfortable with prescribing any opioid. Furthermore, since J&J was providing its competitors with the raw materials (such as poppies in Tasmania), J&J profited even if doctors didn’t prescribe its specific drug.)

Harris’s Proposals for Reforming the Industry

Given the gravity of Harris’s findings, you may be wondering what can be done. Harris argues that J&J’s behavior is symptomatic of a broader problem in the health care industry. He calls for a comprehensive overhaul of the ecosystem around the pharmaceutical industry, including corporations, health care providers, and the government. He argues that fixing this ecosystem requires questioning the for-profit health care model that enabled these abuses.

(Shortform note: Other authors also call for overhauling the US for-profit health care system. In An American Sickness, Elisabeth Rosenthal explains that US health care costs 18% of the country’s GDP, or $3 trillion a year. Yet, overall health outcomes are mediocre compared to other developed countries, which generally spend half of that amount per person.)

Below, we’ll describe four of Harris’s suggestions for overhauling the ecosystem around the pharmaceutical industry.

Proposal 1: Hold Wrongdoers Accountable

According to Harris, a lack of meaningful consequences gives J&J—and other corporations—the green light to continue deceiving the public for a profit. While it’s forced to pay to settle lawsuits from consumers, the payments make a small dent in its profit margins. In addition, individual executives don’t face accountability for their actions. Instead, Harris favors holding pharmaceutical companies and executives accountable in a way that makes it unprofitable for them to continue using harmful strategies.

(Shortform note: In 2018, then-CEO of J&J Alex Gorsky spoke publicly about J&J not being concerned with lawsuit payouts affecting their bottom line—this supports Harris’s claim that lawsuit payments don’t represent significant accountability. Besides giving wrongdoers the sense that they can act with impunity, the lack of meaningful consequences may also deter regulatory agencies. According to experts, when efforts to ban harmful substances have failed in the past, regulatory bodies have often not attempted to try again, resulting in harmful substances remaining readily available.)

Proposal 2: Outlaw Medical Marketing

Harris argues that the government must ban doctors from accepting money or gifts from drug companies and eliminate industry-funded classes that market products at the expense of medical training.

(Shortform note: Research supports Harris’s claim that medical marketing is harmful. A 2019 study found a strong link between manufacturers’ marketing to doctors and increased overdose deaths involving prescription opioids. Counties where doctors received more gifts and fees from opioid makers experienced higher rates of opioid prescriptions and overdose deaths. Further, the study highlights that the frequency of marketing interactions was more strongly associated with overdose deaths than the total amount of money spent. This suggests that even industry-funded classes, which might seem harmless, can be problematic since they add to the frequency of interactions between manufacturers and doctors.)

Proposal 3: Protect Independent Scientific Research

Harris writes that research that can lead to the discovery of new drugs, or that tests the safety and efficacy of existing ones, must be independent. To achieve this, Harris suggests increased data transparency so the information from clinical trials (studies that assess the effect of drugs and treatments) and adverse event reporting (reports on side effects or harm caused by drugs) is freely accessible. He also argues for increased financial transparency to ensure pharmaceutical companies aren’t making direct payments to doctors and scientists participating in research.

The Challenges of Research Transparency

Other experts seem to agree with Harris’s call for financial and data transparency, both in the pharmaceutical industry and beyond. In Ultra-Processed People, Chris van Tulleken argues that the ultra-processed food (UPF) industry should be divorced from scientific research into the effects of UPF—the food industry equivalent of side effects or harm caused by products.

Van Tulleken points out how manufacturers can prejudice research and policy in their favor, yet he also acknowledges the challenges of decoupling government and the food industry. This is partly because research—particularly large-scale studies on humans—is expensive, and large corporations have significantly more money available to fund these studies than universities or governments.

Further, data transparency is tied to financial transparency. In recent years, the FDA has expedited the approval process for new drugs, influenced by increased funding from pharmaceutical companies. This expedited process involves approving medications based on limited or surrogate evidence, such as how much tumors shrink as a result of a drug rather than whether patients’ survival rates improve. In addition, the FDA sometimes relies on a single clinical trial instead of the traditional two.

Proposal 4: Strengthen Regulation

Finally, Harris writes that there must be independent government agencies capable of regulating and sanctioning the pharmaceutical industry. He believes this would require funding the FDA through taxpayers, not industry contributions. In addition, he thinks it’s necessary to create an agency separate from the FDA to investigate products’ safety once they’re on the market, similar to how aviation regulators have two separate agencies for approving new aircraft and for investigating crashes.

(Shortform note: Harris’s proposal mirrors a 2005 recommendation by US Senator Charles Grassley. Following the Vioxx scandal, when an anti-inflammatory drug killed an estimated 55,000 Americans, Grassley pointed out that an agency that’s already under pressure from industry to approve new drugs can’t be expected to effectively assess the drugs’ efficacy or safety after it approves them. As Grassley suggests, there’s an inherent tension between pre- and post-market regulation—and it extends beyond the FDA. In 2025, an investigation into an air crash revealed that the relationship between the two aviation regulators is adversarial. However, experts argue that this can encourage the agencies to keep each other in check.)