No more tears: A journalist’s investigation of unethical practices in the pharmaceutical industry with Gardiner Harris

Transcript

• 00:00First time, I'm Jennifer Miller,
• 00:02co director of the program
• 00:03for biomedical ethics here at
• 00:05Yale with,
• 00:06Ben Tolchin and our associate
• 00:08director Sarah Hall.
• 00:11Before we're in for a
• 00:12treat today. But before I
• 00:13talk about that, let me
• 00:15remind everyone to please text
• 00:17if you need CME five
• 00:19one
• 00:20six six eight.
• 00:22Five one six six eight.
• 00:23And make sure to sign
• 00:25the attendance sheet if you
• 00:27need to do that for
• 00:27credit.
• 00:29Alright. So we're delighted to
• 00:30introduce and welcome home
• 00:33Gardner Harris, a Yale graduate,
• 00:36and one of America's most
• 00:38impactful investigative journalists with a
• 00:40career spanning thirty years.
• 00:43When I say impact,
• 00:45I don't just mean
• 00:47eyeballs
• 00:48reading his stories, although there
• 00:49have been plenty of those.
• 00:51I mean in terms of
• 00:52potential
• 00:53lives saved
• 00:55and protective regulations passed. He's
• 00:57had so many roles over
• 00:59his thirty years. I'm gonna
• 01:00name three.
• 01:01First, one of his early
• 01:03career,
• 01:04placements was as Eastern Bureau
• 01:06chief of the Louisville, Kentucky
• 01:08Courier Journal. There, he investigated
• 01:10the coal industry,
• 01:12uncovering cheating
• 01:14on coal mine air quality
• 01:15tests, exposing thousands of miners
• 01:17to health risks and even
• 01:19death.
• 01:21Due to his he cut
• 01:22his coverage on the cheating,
• 01:23he won a Polk award.
• 01:25It led to three arrests
• 01:26and an overhaul of coal
• 01:27mine safety laws. He then
• 01:29moved on to the Wall
• 01:30Street Journal where he became
• 01:32the lead pharmaceutical reporter.
• 01:34Among his many stories
• 01:36was a report on BMS's
• 01:38inappropriate
• 01:39financial engineering, which led to
• 01:41the second largest fine in
• 01:43SEC history,
• 01:44criminal charges against top officials,
• 01:47and the departure of the
• 01:49company's CEO.
• 01:52He then
• 01:53moved on to The New
• 01:54York Times
• 01:56as a public health reporter.
• 01:58His investigations
• 01:59led to the withdrawal of
• 02:00several drugs
• 02:02due to safety concerns, risks
• 02:04Gardner describes as known by
• 02:05companies but hidden from the
• 02:07public
• 02:08for years.
• 02:10He also has covered hidden
• 02:11payments between pharmaceutical companies and
• 02:13academia.
• 02:14This work informed the passage
• 02:16and led led to the
• 02:17passage of the physician payments
• 02:19sunshine act, which requires
• 02:21pharmaceutical and medical device companies
• 02:23to publicly report
• 02:25their payments to physicians and
• 02:26teaching hospitals.
• 02:28In twenty nineteen, he left
• 02:30daily journalism to write no
• 02:32more tears,
• 02:34a page turning,
• 02:35damning expose on j and
• 02:37j, to paraphrase AP and
• 02:39other,
• 02:40people.
• 02:41J and j has historically
• 02:43been one of America's most
• 02:44trusted institutions
• 02:46up until about nineteen years
• 02:47ago. It was ranked number
• 02:49one
• 02:50and among the largest health
• 02:51care conglomerates in the world.
• 02:53After this talk, I expect
• 02:55we all may work walk
• 02:56out morally outraged
• 02:58by his meticulous accounting
• 03:00of repeated unethical practices spanning
• 03:02decades,
• 03:04suggesting the problems presented are
• 03:05not outliers, were not the
• 03:07product of rogue employees, or
• 03:09rearview mirror problems that have
• 03:10since been fixed,
• 03:12but rather potentially
• 03:13representing a rotten barrel
• 03:15at many points in time,
• 03:17raising questions of whether any
• 03:18good apples can survive
• 03:20rotting from a corrupted economy
• 03:21of of incentives
• 03:24that are not in the
• 03:24interest of patients and the
• 03:25public.
• 03:27So please help me in
• 03:28welcoming Gardner Harris back home
• 03:29to Yale. Thank you.
• 03:38I walked around campus today.
• 03:39It was so great. I
• 03:41have not been here in
• 03:42years. You are so lucky
• 03:44to be in this place
• 03:45even when the weather is
• 03:46terrible.
• 03:47And I got to meet
• 03:49Terry Bradshaw, the, you know,
• 03:50great NFL quarterback who was
• 03:52staying in my hotel today,
• 03:54which was just like the
• 03:55whole trip is worth it.
• 03:57Okay.
• 03:58Yeah. And he actually talked
• 03:59to me, like, as nice
• 04:01a guy as he seems
• 04:02on the Fox broadcast.
• 04:04So
• 04:05I'm thrilled to be here.
• 04:08So,
• 04:10let me just sort of
• 04:11dive right in.
• 04:13Here, I just wanna outline
• 04:14what I'm gonna talk about
• 04:15today.
• 04:17I'll talk briefly about my
• 04:18motivation for doing the book.
• 04:20I'm gonna go through some
• 04:22of the documents of some
• 04:23of the specific crimes that
• 04:25Johnson and Johnson
• 04:26was engaged in. I'll talk
• 04:28a little bit about the
• 04:29reception of the book. We'll
• 04:30go through some solutions
• 04:32because I think this is
• 04:33a real solutions oriented crowd,
• 04:36and then, hopefully, we'll have
• 04:38a good discussion.
• 04:40And,
• 04:42I've I've got forty five
• 04:43minutes and, you know,
• 04:45now.
• 04:47So,
• 04:49there have been some terrific
• 04:50books on the opioid crisis.
• 04:52I'm sure you all have
• 04:53read some of these. They're
• 04:54award winning. They're amazing,
• 04:56and they drove me nuts.
• 05:00None of these books were
• 05:01written by health care writers.
• 05:02They were written by
• 05:05writers who came from other
• 05:07areas.
• 05:08And I and I there
• 05:10was a sense in reading
• 05:11them that it was an
• 05:13alien coming into
• 05:15your own land. And they
• 05:18what was difficult for me
• 05:20about the opioid
• 05:22books and even some of
• 05:23the coverage,
• 05:24The New York Times, I
• 05:26will tell you, did not
• 05:27distinguish itself in my opinion,
• 05:29in this coverage.
• 05:31But
• 05:33these stories
• 05:34all sort of suggested there
• 05:35was something unique going on
• 05:37in the opioid crisis,
• 05:39that the payments to doctors,
• 05:41that the
• 05:42academic
• 05:43perfidy, frankly, in in the
• 05:46opioid crisis,
• 05:48that the fact that it
• 05:50continued on, the fact that
• 05:51the federal government really did
• 05:53nothing to stop all this,
• 05:55that that somehow
• 05:57was unique to opioids when
• 05:59in fact
• 06:00it is the system as
• 06:02we know it across the
• 06:04board.
• 06:05So,
• 06:06in in reading these books,
• 06:09it
• 06:10I had done pharma for
• 06:12a very long time, and
• 06:13then I kind of lost
• 06:14my mind and became,
• 06:16a foreign correspondent for The
• 06:17New York Times, a White
• 06:18House correspondent, and a diplomatic
• 06:20correspondent. I wanted to sort
• 06:21of try those other things.
• 06:23But,
• 06:24I always kept an eye
• 06:25on public health. And in
• 06:27fact,
• 06:28I did a lot of
• 06:29public health stories when I
• 06:30was in India. If you
• 06:31know that India's air pollution
• 06:33is bad, it's because of
• 06:34the series that I did,
• 06:37showing that to the Indians
• 06:38and to the world
• 06:39and the profound public health
• 06:41effects of that. Same thing
• 06:43with,
• 06:44sanitation in India. I did
• 06:45a series that led the
• 06:46government to build more than
• 06:48a hundred million toilets,
• 06:50and and sort of brought
• 06:51that
• 06:52that idea to these other
• 06:54beats. But but, really,
• 06:56I think the most important
• 06:58story in in America is
• 07:00really the health care story,
• 07:01what you guys are engaged
• 07:03in, and I eventually came
• 07:04back to it.
• 07:06And I wanted to do
• 07:07something,
• 07:09let's say,
• 07:11more expansive
• 07:12than the books on opioids,
• 07:14which focused only on opioids.
• 07:16And in my opinion,
• 07:18the most important story that
• 07:20just never really left me
• 07:21was Johnson and Johnson. It's
• 07:23it's by far and away
• 07:24the largest health care products
• 07:26conglomerate,
• 07:27in the world. It's, as
• 07:29Jennifer said,
• 07:30has topped the most admired
• 07:32lists forever,
• 07:35and yet is the the
• 07:36author of by far and
• 07:37away the deadliest crimes in
• 07:39American history,
• 07:41with at least
• 07:42contributing
• 07:43causing or contributing to at
• 07:44least two million
• 07:46deaths in the United States.
• 07:47And and so,
• 07:50rather than focus on Purdue
• 07:52Pharma and the Sacklers, which
• 07:53is which was always a
• 07:55tiny company. You know, Purdue
• 07:56Pharma's
• 07:57maximum revenues annual revenue is
• 08:00three billion dollars.
• 08:02Johnson and Johnson, prior to
• 08:03the spin off
• 08:05of of of KenView, it
• 08:06would be around a hundred
• 08:08and twenty,
• 08:09billion dollar million dollars annually.
• 08:12So it is it is
• 08:14thirty to forty times larger
• 08:16than Purdue Pharma. And
• 08:19one of the
• 08:20one of the facts that
• 08:22just
• 08:22I thought was so important
• 08:24was
• 08:25even during the height of
• 08:26the prescription opioid crisis, you
• 08:28know, there have been three
• 08:29different opioid crises. We're now
• 08:31in the Mexican fentanyl one.
• 08:32But the beginning one was
• 08:34the prescription opioid crisis.
• 08:36I was in Hazard, Kentucky,
• 08:38in ninety six when OxyContin
• 08:40was
• 08:41was launched.
• 08:43I watched it rip through,
• 08:45my town and my region.
• 08:49About fifteen percent of the
• 08:50bodies that showed up in
• 08:51morgues during that period of
• 08:52time had a Purdue Pharma
• 08:54Sackler product in their system.
• 08:56Around sixty percent had a
• 08:58J and J product in
• 08:59their system.
• 09:00Why don't you know that?
• 09:02And you don't know that
• 09:04because of spectacular
• 09:05failings
• 09:06on my part and the
• 09:08part of my industry journalists.
• 09:11Because
• 09:11John's Purdue Pharma was an
• 09:14easy target.
• 09:15It did not have
• 09:17an army of lobbyists
• 09:19in Washington.
• 09:20It did it was not
• 09:21one of the largest advertisers
• 09:23in the New York Times
• 09:25and every other media organization.
• 09:28It did not have consultants
• 09:30in almost every major academic
• 09:32medical center, including this one.
• 09:34Johnson and Johnson has all
• 09:36of those.
• 09:37That's why you don't know
• 09:38that fact about the opioid
• 09:40crisis.
• 09:41So,
• 09:42my motivation in this, I
• 09:44I put up a picture
• 09:45of one of your rivals,
• 09:46Princeton. I actually spent my
• 09:47middle school years in Princeton,
• 09:50which is very close to
• 09:51where Johnson and Johnson is
• 09:53is,
• 09:54is headquartered.
• 09:55Many of the kids that
• 09:56I went to school with,
• 09:57their parents worked at Johnson
• 09:59and Johnson.
• 10:00My football meet my football
• 10:02games and swim meets,
• 10:04had the classic curly cue
• 10:07logo of Johnson and Johnson
• 10:09on the sidelines.
• 10:10It was
• 10:12anybody who was invited to
• 10:13the Christmas party put on
• 10:14the by the Johnson family
• 10:16had arrived in Princeton. It
• 10:18was it was widely seen
• 10:20as, you know, a royal
• 10:22event. And we and,
• 10:24we all admire Johnson and
• 10:25Johnson as really
• 10:27kind of the
• 10:29the best of capitalism,
• 10:31which is that you could
• 10:32do well financially and do
• 10:34good in the world.
• 10:36And that was the image
• 10:37of Johnson and Johnson that
• 10:38I really
• 10:40grew up with. Then I
• 10:41went to the Wall Street
• 10:42Journal, and the big,
• 10:45the big story when I
• 10:46first joined the paper
• 10:48was AIDS in Africa.
• 10:52The United States had developed
• 10:53ARVs, these antiretroviral
• 10:55drugs.
• 10:56We'd come up with a
• 10:57cocktail that turned AIDS from
• 10:59a deadly disease into a
• 11:01chronic illness,
• 11:02but they were so expensive
• 11:04that
• 11:05Africans couldn't have them. So
• 11:07there was this campaign to
• 11:09get the industry
• 11:10to allow Indian generic makers
• 11:12to copy these drugs and
• 11:14sell them for cheap in
• 11:16Africa. And when the price
• 11:18of a combined
• 11:19of the three,
• 11:20three three part cocktail came
• 11:22down to a dollar a
• 11:23day,
• 11:24a whole bunch of countries
• 11:25and philanthropists stepped up and
• 11:27said, that's a price point
• 11:29at which we will
• 11:31buy enough for
• 11:32the,
• 11:33the continent, and they did.
• 11:35So, you know, through a
• 11:37whole bunch of stories that
• 11:38I wrote and my colleagues
• 11:40wrote, we were able to
• 11:41get the industry
• 11:43to do this really important
• 11:45thing, and there was just
• 11:46one holdout, and that was
• 11:48Johnson and Johnson.
• 11:49Johnson and Johnson was the
• 11:51only and remains
• 11:53the only major manufacturer of
• 11:55HIV AIDS medicines
• 11:57that refuses to participate in
• 11:59a program
• 12:00that saved the continent of
• 12:02Africa.
• 12:03And at the time, I
• 12:04was like, there must be
• 12:05some mistake here. Like, how
• 12:07is this possible? This is
• 12:09widely thought to be the
• 12:10most ethical company in the
• 12:12world.
• 12:13How is it the loan
• 12:15holdout?
• 12:17And then,
• 12:18a couple years later, my
• 12:19own son was born.
• 12:21This is not a picture
• 12:22of him. It's when I
• 12:23got off the Internet,
• 12:25but he was born early.
• 12:26He spent
• 12:28several days in a NICU
• 12:29unit. Anybody who's
• 12:32had children
• 12:33and had difficulties early on
• 12:35knows that it's one of
• 12:37the most difficult things you
• 12:38go through.
• 12:39And,
• 12:40at the time, there was
• 12:41no such thing as paternity
• 12:43leave. So,
• 12:44as soon as my son
• 12:46came back from the hospital,
• 12:47I went right back to
• 12:48work and
• 12:49received
• 12:50a tranche of documents
• 12:52from whistleblower
• 12:53showing that Johnson and Johnson
• 12:55had, for years, sold this
• 12:57heartburn medicine called Propulsid.
• 13:00They they had tried to
• 13:02test it in infants and,
• 13:03in fact, had undertaken twenty
• 13:06separate clinical trials in children,
• 13:10to to prove that Propulsid
• 13:12worked to prevent spit up.
• 13:15Any of you who are
• 13:16part of an ethics program
• 13:18know that children are protected
• 13:20class, and you are not
• 13:21allowed
• 13:22to
• 13:23undertake any clinical trials in
• 13:25children unless you have a
• 13:27very good idea that it's
• 13:28gonna be beneficial for them.
• 13:30So after the third clinical
• 13:32trial that they'd launched in
• 13:33kids, they should not have
• 13:35been able to launch the
• 13:36fourth, never mind the fifth,
• 13:38the tenth, the fifteenth, and
• 13:40the twentieth. But they did.
• 13:42They all
• 13:43failed,
• 13:44which proved beyond a shadow
• 13:46of a doubt that this
• 13:47drug did not was not
• 13:48helpful in kids.
• 13:49And the company knew that
• 13:51it had a particular
• 13:53problem for children, which is
• 13:54that it caused QT prolongation,
• 13:56which is kind of a
• 13:57heart arrhythmia. And in preemies,
• 14:00heart arrhythmias, as
• 14:02our cardiologist
• 14:03knows,
• 14:04they are particularly
• 14:05dangerous. These children are hanging
• 14:08by gossamer threads to life.
• 14:10And if you give them
• 14:11a heart arrhythmia,
• 14:12it, on rare occasions, will
• 14:14kill them. So Johnson and
• 14:16Johnson had this growing pile
• 14:17of dead babies,
• 14:19they knew,
• 14:20and and the FDA was
• 14:22increasingly panicked
• 14:24asking the company why
• 14:26neonatologists
• 14:27were prescribing this medicine when
• 14:30it was known not to
• 14:31work. And Johnson and Johnson
• 14:32kept telling the FDA, we
• 14:34don't know, which was a
• 14:35lie because Johnson and Johnson
• 14:37was actually underwriting
• 14:38an illegal marketing effort to
• 14:40get neonatologists
• 14:42to prescribe this drug. And
• 14:43in fact, one fifth of
• 14:45all children in NICU units
• 14:48at the end of the
• 14:48nineteen nineties
• 14:50were prescribed Propulsid, which is
• 14:52why so many of them
• 14:53died. So here, my own
• 14:55son had just been in
• 14:57this NICU unit, and I
• 14:58get all these documents showing
• 15:00that this is a company
• 15:01that targeted
• 15:02NICU babies
• 15:04just like mine. Now my
• 15:06child didn't get this, but
• 15:07I was
• 15:09stunned
• 15:09that this company was knowingly
• 15:12killing babies. That's the only
• 15:14way to interpret their propulsive
• 15:16story.
• 15:18And then I as I
• 15:19talk about in the book,
• 15:20I had
• 15:22I was coming back from
• 15:23a ski trip in two
• 15:24thousand four, and,
• 15:26I saddled up to a
• 15:27bar to watch a March
• 15:28Madness game. It was, you
• 15:30know, right this time of
• 15:31year. And the woman next
• 15:33to me turned out to
• 15:34be a J and J
• 15:35sales rep, and she told
• 15:36me a story about selling
• 15:38an antipsychotic
• 15:39to children
• 15:40that just stuck with me,
• 15:42really for the rest of
• 15:43my life.
• 15:45And,
• 15:46it was about her nephew
• 15:48and the terrible things that
• 15:49happened to her nephew that
• 15:51made her realize that what
• 15:52she was doing on a
• 15:53day to day basis was
• 15:54not just illegal, but horribly
• 15:57unethical.
• 15:59Like so many stories we
• 16:01we get as journalists, I
• 16:02was not able to tell
• 16:03this one in the paper
• 16:04because she wouldn't give me
• 16:06her name.
• 16:07And so I said goodbye
• 16:09to her and never saw
• 16:10her again. I would later
• 16:12get,
• 16:13grand jury files of the
• 16:15investigation in into Risperdal, and
• 16:17I got
• 16:18in the grand jury files
• 16:19were,
• 16:20employee rosters and all their
• 16:22cell phone numbers. And
• 16:24I
• 16:25searched and searched and searched
• 16:27for this woman, but but
• 16:28never found her.
• 16:29So,
• 16:32I decided
• 16:33at some point,
• 16:34this stuck with me
• 16:36even doing the White House
• 16:38and doing diplomacy. I just
• 16:40I had to go do
• 16:41this, but I decided I
• 16:43needed I needed
• 16:45a strategy that was different
• 16:47than the opioid books. Like,
• 16:49I wanted to cover not
• 16:50just drugs. I wanted to
• 16:52cover devices and consumer products
• 16:54as well, which is what
• 16:55Johnson and Johnson
• 16:56did. I I wanted to
• 16:57look not just at the
• 16:58opioid period, but decades of
• 17:01behavior for this company.
• 17:03And I I wanted to
• 17:05overwhelm
• 17:06people with evidence.
• 17:09If you have looked at
• 17:10the book, you will know
• 17:11that I have eighty pages
• 17:12of endnotes at the back.
• 17:15I have my own website
• 17:16with, you know, hundreds of
• 17:18thousands of pages of documents.
• 17:22I got grand jury files.
• 17:23It's you know,
• 17:25you all are now hearing
• 17:26about the Epstein case. What's
• 17:28remarkable,
• 17:29as you know about the
• 17:30Epstein case, is it's really
• 17:32the first time we are
• 17:33seeing
• 17:34grand jury files come out
• 17:36publicly.
• 17:37And grand jury files are
• 17:39extraordinarily
• 17:40detailed. And the
• 17:42grand juries are the last
• 17:44truly secret institutions in American
• 17:46life. I was a White
• 17:47House correspondent. We got
• 17:49national security secrets fairly routinely.
• 17:51You know, they show up
• 17:53in in bathrooms at Mar
• 17:54a Lago and in garages
• 17:57in in Wilmington, Delaware.
• 18:00It's not that unusual for
• 18:01those sort of deep dark
• 18:03national security secrets to see
• 18:04the light of day. It
• 18:06almost
• 18:06never happens with grand juries,
• 18:08and you are now seeing
• 18:10why.
• 18:11Because
• 18:12what happens when you see
• 18:14grand jury files is you
• 18:15see this extraordinary
• 18:17skein
• 18:18of illegal and unethical
• 18:21activity
• 18:21that spreads
• 18:23across
• 18:24huge numbers of people. Right?
• 18:26Now these people are all
• 18:28losing their jobs or many
• 18:29of them are
• 18:30not because
• 18:31they did anything criminal, they
• 18:33because they did stuff that's
• 18:34unethical.
• 18:36I got the files for
• 18:37three separate grand juries, and
• 18:40I can tell you that
• 18:41that skein of unethical and
• 18:43illegal conduct
• 18:45in each one of these
• 18:46things is just as vast
• 18:48and includes
• 18:49Yale New Haven. It includes
• 18:51every hospital in this country,
• 18:54Particularly when we talk about
• 18:55the EPO case,
• 18:56everyone
• 18:57was involved.
• 19:00So,
• 19:01I decided to start off
• 19:02with Johnson's baby powder, which
• 19:03I actually think is sort
• 19:05of the most iconic product.
• 19:07Oh, it's among the most
• 19:08iconic products ever sold.
• 19:10I think it really kind
• 19:11of encapsulates
• 19:13this story.
• 19:14David Kessler, who's arguably the
• 19:16most famous FDA commissioner, has
• 19:19called Johnson and Johnson's
• 19:21fraud about Johnson's baby powder
• 19:23the worst fraud ever,
• 19:26conducted on the FDA. He
• 19:28he thinks
• 19:29it is it is by
• 19:30far and away the worst
• 19:31crime.
• 19:33And,
• 19:34you know, what what happened
• 19:36in the Johnson baby powder
• 19:39situation is obviously, Johnson's baby
• 19:41powder was made with talcum
• 19:43powder for most of its
• 19:45history.
• 19:46Talcum powder,
• 19:47and asbestos,
• 19:49talc and asbestos deposits
• 19:51are always found together.
• 19:53And,
• 19:55and it used to be
• 19:56that the asbestos mines in
• 19:57the United States used to
• 19:58be right next to talc
• 20:00mines because
• 20:02the two that both asbestos
• 20:04and talc are basic are
• 20:06almost chemically identical, and it
• 20:08just is a difference a
• 20:09little bit in pressure and
• 20:11time depending upon whether
• 20:12these,
• 20:13elements turn into talc or
• 20:15turn into asbestos,
• 20:17and they're usually ribboned amongst
• 20:19each other. And,
• 20:21and
• 20:23this was known forever.
• 20:25Johnson and Johnson
• 20:26was sued beginning in nineteen
• 20:28seventy nine
• 20:29for mesa for
• 20:31people who got mesothelioma
• 20:33and ovarian cancer,
• 20:35and people claimed that, you
• 20:37know, there was asbestos in
• 20:40Johnson's baby powder.
• 20:41The company denied
• 20:44that they had any documents
• 20:45showing the baby powder had
• 20:47asbestos in it from nineteen
• 20:49seventy nine until around two
• 20:51thousand fifteen. As you may
• 20:53know,
• 20:54if you get sued, you
• 20:55are required to disclose
• 20:57documents
• 20:59that relate to the lawsuit.
• 21:01And for thirty five years,
• 21:03basically, Johnson and Johnson said
• 21:05they did not have a
• 21:06single document showing that asbestos
• 21:09was ever present in any
• 21:10of its talc products or
• 21:12Johnson's baby powder. Those were
• 21:14lies.
• 21:15And
• 21:16many of the lawyers
• 21:18making those protestations
• 21:20in court
• 21:21knew they were lies because
• 21:22they were at
• 21:24depositions of people who went
• 21:26through many of these documents.
• 21:28So these lawyers,
• 21:29including one who worked at
• 21:31the law firm that the
• 21:33New York Times used
• 21:35to fight all of our
• 21:36first amendment cases,
• 21:38these were some of the
• 21:39most august lawyers in the
• 21:41country making the world safe
• 21:43to poison America's
• 21:45babies and mothers.
• 21:47And they did this for
• 21:49decades.
• 21:50And finally, in two thousand
• 21:52and fifteen,
• 21:54one of these law firms,
• 21:56got caught,
• 21:57in hiding these documents. They
• 21:59were
• 22:00charged,
• 22:01they settled the case for
• 22:02a hundred million dollars because
• 22:04an appeals court pointed out
• 22:05that the lawyers themselves
• 22:07may be subject to criminal
• 22:09sanctions.
• 22:11So once the appeals court
• 22:12said that,
• 22:13these law firms started discouraging
• 22:16some of these documents.
• 22:17And it was only really
• 22:19then
• 22:20that
• 22:21this explosion in cases,
• 22:23there are now ninety thousand
• 22:25people who have sued Johnson
• 22:26and Johnson
• 22:27over Johnson's baby powder. It
• 22:29was only once the company
• 22:31finally started discouraging these documents
• 22:34that those cases really started
• 22:36being filed. And the earliest
• 22:38document
• 22:39that shows,
• 22:41asbestos in Johnson's baby powder
• 22:43is nineteen fifty eight,
• 22:45in which, you know,
• 22:47this
• 22:48actually, this Ohio lab
• 22:51tested Johnson's baby powder, and
• 22:53we they were hired by
• 22:54Johnson Johnson to tell the
• 22:56company
• 22:57how best to make the
• 22:59powder
• 23:00feel even smoother.
• 23:01And this lab,
• 23:04Battelle Memorial Institute,
• 23:06basically said, well, you gotta
• 23:07get the asbestos out of
• 23:08it.
• 23:10And and I just put
• 23:11up a couple of these.
• 23:12And then in nineteen sixty
• 23:15nine,
• 23:17some of the
• 23:19memos that that start proliferating
• 23:21within Johnson and Johnson,
• 23:23one of the early ones
• 23:25is one that talks about
• 23:27the legal risks the company
• 23:29may face
• 23:30if people realize
• 23:31tremolite is a form of
• 23:33asbestos,
• 23:34if people realize just how
• 23:36much asbestos is in Johnson's
• 23:37baby powder.
• 23:39And, again, you can see
• 23:40this in my book.
• 23:42You can see it in
• 23:43my end notes. There are
• 23:44now
• 23:45hundreds of these documents that
• 23:46have since come out showing
• 23:48that Johnson's baby powder,
• 23:50is had you know, was
• 23:52historically
• 23:53contaminated with asbestos.
• 23:55And in fact, finally, the
• 23:56FDA
• 23:57tested Johnson's baby powder in
• 24:00two thousand and nineteen.
• 24:01And, of course, FDA found
• 24:03asbestos in Johnson's baby powder.
• 24:05And,
• 24:06again, in
• 24:07as you may
• 24:09if you read the book,
• 24:10you will see that this
• 24:11is a profile of Johnson
• 24:13and Johnson, but it's also
• 24:14a profile of the FDA
• 24:16and just how poorly the
• 24:18FDA
• 24:19has handled these things and
• 24:21how poorly the FDA protects
• 24:22the rest of us. And
• 24:24so finally,
• 24:26you know, essentially essentially, a
• 24:28century later, the FDA tests
• 24:29this, finds asbestos.
• 24:32They then tell Johnson and
• 24:33Johnson,
• 24:34we found this. We'll give
• 24:36you five days to come
• 24:37up with a response.
• 24:39And this is like again,
• 24:41the FDA knows that people
• 24:43are dusting themselves and their
• 24:45babies
• 24:46with a product that is
• 24:48contaminated with asbestos,
• 24:50and they don't announce this
• 24:51immediately.
• 24:52They let five days pass
• 24:54until finally they announced it.
• 24:55And, of course, Johnson and
• 24:57Johnson claims that FDA's test
• 24:59was flawed.
• 25:01I then go through the
• 25:02history of Tylenol. Tylenol
• 25:05this is extra strength Tylenol,
• 25:07five hundred milligrams.
• 25:08Tylenol is the only medicine
• 25:12in which the prescription
• 25:14strength
• 25:14is three hundred and twenty
• 25:16five milligrams,
• 25:17and the over the counter
• 25:18strength is five hundred milligrams.
• 25:22The only one.
• 25:24If not, coincidentally,
• 25:26Tylenol is also by far
• 25:28the most deadly over the
• 25:30counter medicine sold in the
• 25:32world, causes more death and
• 25:33injury
• 25:34than all other over the
• 25:36counter medicines
• 25:37combined.
• 25:39And the guy who actually
• 25:41lowered the prescription strength to
• 25:43three twenty five, doctor Josh
• 25:45Sharfstein,
• 25:47who was the acting FDA
• 25:48commissioner in the early Obama
• 25:50years and then the dep
• 25:51the principal deputy,
• 25:53will tell you that he
• 25:54lowered the prescription strength in
• 25:56hopes of shaming Johnson and
• 25:58Johnson
• 25:59into stopping selling
• 26:02extra strength,
• 26:05Tylenol.
• 26:06He didn't know Johnson and
• 26:07Johnson that well if he
• 26:08thought that he could shame
• 26:10them into anything.
• 26:12So I actually tell one
• 26:14of the most famous stories
• 26:16about Tylenol, which is the
• 26:17nineteen eighty two Tylenol poisoning
• 26:19scare, which we've all heard
• 26:21about and
• 26:22which every business school in
• 26:24the country teaches is the
• 26:26model of crisis
• 26:28response where
• 26:29Johnson and Johnson allegedly responded
• 26:32to this poisoning in the
• 26:33ideal way, withdrawing its product
• 26:35and then and then rereleasing
• 26:38it with all of these
• 26:39seals and controls.
• 26:44I you know, I'm not
• 26:45suggesting that Johnson and Johnson
• 26:47was responsible
• 26:48for these seven deaths. And
• 26:50in fact,
• 26:51it is widely recognized that
• 26:53there were at least four
• 26:54other deaths that were not
• 26:55part of the original seven.
• 26:57But,
• 26:58I
• 26:59I think I argue persuasively
• 27:01in the book that their
• 27:02response was far from ideal,
• 27:04and
• 27:05and,
• 27:06I don't think it's a
• 27:07coincidence that Harvard no longer
• 27:09teaches
• 27:10its case study
• 27:12on the nineteen eighty two
• 27:14Tylenol poisoning scare, which up
• 27:16to that point, and I
• 27:17think to this day still,
• 27:19is the most widely
• 27:21used case study in business
• 27:23and communication schools in the
• 27:24country, and it's completely wrong.
• 27:28What what is most important,
• 27:30as we talked about about
• 27:31Tylenol, is not that nineteen
• 27:33eighty two case, but
• 27:35but these deaths to this
• 27:37day.
• 27:38And,
• 27:41you know, it's it's it's
• 27:42an incredibly deadly drug, and
• 27:44the reason it's so deadly
• 27:46is because its advertising campaign
• 27:49is
• 27:50suggests that it's so safe.
• 27:52People,
• 27:54in interviews
• 27:55constantly
• 27:56say when they suffer liver
• 27:59damage or
• 28:00liver death,
• 28:02I I just didn't think
• 28:03it would be a problem
• 28:04because it's thought to be
• 28:06so safe.
• 28:07That's the, well, that's the
• 28:09ad campaign that says
• 28:11it's the pain reliever hospitals
• 28:13use most. There's obviously others
• 28:16that doctors use the most,
• 28:17that pediatricians
• 28:18use the most.
• 28:20We can talk about the
• 28:22recent,
• 28:24maybe in the question and
• 28:25answer session, we can talk
• 28:26about the recent,
• 28:28debate about whether Tylenol is
• 28:30associated with autism.
• 28:32I
• 28:33I think, unfortunately, my colleagues,
• 28:36my former colleagues
• 28:38didn't do that story justice.
• 28:40I think there are reasons
• 28:42to be concerned about Tylenol
• 28:44in the in the early
• 28:45pediatric space.
• 28:48But, again, I'm happy to
• 28:49talk about that. I will
• 28:51tell you in most of
• 28:52my book talks, you know,
• 28:53books are read mostly by
• 28:55elderly people,
• 28:56that, you know, it's the
• 28:57conversation about Tylenol that that
• 28:59shocks them the most.
• 29:02Then I go through,
• 29:05prescription drugs, and the two
• 29:07really that I go through
• 29:08the most are Procrit and
• 29:10Risperdal. Procrit,
• 29:12is also it's known as
• 29:14EPO. I'm sure many of
• 29:15you have heard about EPO.
• 29:16Most people have heard about
• 29:17EPO because Lance Armstrong and
• 29:19the US postal team
• 29:21used it to dope to
• 29:22win seven tours to France.
• 29:24It's it's so it's
• 29:26it's effect on athletic performance
• 29:29is what, sort of is
• 29:30most famous, but Procrit
• 29:32for fifteen years was the
• 29:34most widely prescribed cancer drug
• 29:37in the United States.
• 29:38And that's because Johnson and
• 29:40Johnson decided
• 29:42that,
• 29:42what what Procrit does is
• 29:44stimulates your,
• 29:46your bone marrow to produce
• 29:47red blood cells.
• 29:49And if and it's sort
• 29:51of a a little pick
• 29:52me up, basically. And Johnson
• 29:54and Johnson decided
• 29:56what happens,
• 29:57in in cancer is people
• 29:59take very tough chemotherapeutics
• 30:02that can lead them to
• 30:03become briefly anemic.
• 30:05And Johnson and Johnson basically
• 30:07said, okay. Well, if we
• 30:08give you Procrit, if we
• 30:09give you EPO,
• 30:11you'll you will you're less
• 30:13likely to get anemia, and
• 30:14you'll feel stronger so that
• 30:16you can take
• 30:18tougher chemotherapeutics.
• 30:20What was clear is from
• 30:21day one, Johnson and Johnson
• 30:23knew that Procrit was miracle
• 30:26grow to tumors.
• 30:28So rather than I mean,
• 30:29if you're taking chemotherapeutics,
• 30:31you're taking them to make
• 30:33your tumors shrink or disappear.
• 30:35And instead, Johnson and Johnson
• 30:37was giving you a medicine
• 30:38to make your tumors grow
• 30:40and thrive,
• 30:41and they knew it because
• 30:43they actually launched
• 30:45as soon as they started
• 30:46selling Procrit to cancer patients,
• 30:48they secretly had
• 30:50a research program on making
• 30:52an anti Procrit
• 30:54to shrink tumors.
• 30:55So and they were so
• 30:57successful
• 30:58in this that Procrit was
• 31:00by far and away the
• 31:01most widely used drug in
• 31:03cancer,
• 31:04and in fact, was for
• 31:06many years the single largest
• 31:08expense
• 31:09of the federal government.
• 31:12Like,
• 31:13more than it spent on
• 31:14aircraft carriers, air you know,
• 31:16anything. It was procreate,
• 31:19because half of all cancer
• 31:21patients was were taking it.
• 31:22And as you know, the
• 31:23Medicare program, which is the
• 31:25federal
• 31:26insurance program for the elderly,
• 31:27basically
• 31:28spends
• 31:30buys nearly all cancer medicines,
• 31:32certainly all infused cancer medicines,
• 31:34which is what Procrit was.
• 31:36And so
• 31:38the way Johnson and Johnson
• 31:41really encouraged
• 31:42the sales of Procrit is
• 31:44that and they
• 31:46companies still do this with
• 31:48with cancer medicines, is they
• 31:49added about fifteen percent
• 31:52extra medicine to their vial.
• 31:54So they would say that
• 31:56they would sell you a
• 31:57hundred
• 31:58international units appropriate, but they
• 32:00would actually
• 32:01give you a hundred and
• 32:02fifteen international units
• 32:04with,
• 32:05your vial.
• 32:07And
• 32:08almost every cancer hospital in
• 32:10the country then hired compounding
• 32:12pharmacies
• 32:13to repackage the Procrit
• 32:15so that they could then
• 32:17use that extra fifteen milliliters
• 32:20as if they'd paid for
• 32:21it and charge Medicare
• 32:23and private insurers as if
• 32:25they had paid full freight.
• 32:27So the only reason you
• 32:29would hire
• 32:30a compounding pharmacy is because
• 32:32you are aware that you
• 32:34were engaged
• 32:35in massive insurance fraud and
• 32:37want to do that more
• 32:39efficiently.
• 32:40And almost every hospital in
• 32:42the country, and I believe
• 32:43Yale New Haven is among
• 32:45them,
• 32:46hired compounding pharmacies
• 32:48to do this
• 32:49so that they could engage
• 32:51in the largest
• 32:53case of insurance fraud
• 32:55in American history.
• 32:57One, hundreds of billions of
• 32:59dollars were stolen from taxpayers
• 33:02and private insurers this way.
• 33:04And the money was so
• 33:06good
• 33:06that it that the average
• 33:08oncologist in the country made
• 33:09about three hundred thousand dollars
• 33:11in their in their clinical
• 33:13practices
• 33:14and then made an additional
• 33:15three hundred thousand dollars just
• 33:17in their appropriate prescriptions.
• 33:20Because oncology,
• 33:22I'm sorry to tell you,
• 33:23is one of the most
• 33:24corrupt forms of medicine
• 33:26because
• 33:26oncologists
• 33:27make
• 33:29make about half their income.
• 33:32They they serve as both
• 33:33doctor and pharmacist,
• 33:35uniquely in medicine, and they
• 33:37make much of their income
• 33:39on their drug markups.
• 33:41You wanna know why Americans
• 33:42get far more aggressive chemotherapy
• 33:45than
• 33:45European cancer patients?
• 33:47You wanna know why but
• 33:49I always love to ask
• 33:50this question. I this was
• 33:52true
• 33:53a bunch of years ago,
• 33:54but guess the average amount
• 33:56of time that a patient
• 33:57at Memorial Sloan Kettering spends
• 33:59on hospice care. You know,
• 34:01huge share of Memorial's patients
• 34:02die because it's the tertiary
• 34:04cancer center. People get referred
• 34:06there oftentimes
• 34:08too late,
• 34:09so an enormous number. So
• 34:12they're gonna die.
• 34:14Anybody
• 34:15guess, like sure.
• 34:18Yeah. It's eighteen hours.
• 34:20So,
• 34:21so they are treating
• 34:23dead bodies in these cancer
• 34:25hospitals.
• 34:26And, of course, if you
• 34:27talk to oncologists, they will
• 34:29say,
• 34:29it's not our fault. Patients
• 34:31don't really wanna, you know,
• 34:34read the tea leaves that
• 34:35what's really happening.
• 34:37But if they were not
• 34:38if they and their institutions
• 34:40were not
• 34:42so fully invested
• 34:44in the, you know, the
• 34:45money that flows in on
• 34:47these intensive care chemotherapeutics,
• 34:49I'm guessing
• 34:51they might be able to
• 34:52have these conversations
• 34:54in earlier and in a
• 34:55little bit better.
• 34:57So that's the Procrit story,
• 34:58which,
• 34:59like, what's amazing about telling
• 35:01the Procrit story is
• 35:03ask your average oncologist
• 35:05about the Procrit scandal,
• 35:07and they will have no
• 35:08idea what you're talking about.
• 35:10None.
• 35:10Like, it is by far
• 35:12and away the biggest drug
• 35:13disaster in cancer history.
• 35:15It cost an estimated five
• 35:17hundred thousand lives. I'm hoping
• 35:19somebody in this audience may
• 35:21count these dead bodies and
• 35:22and and publish.
• 35:24I was not able to
• 35:25get that. I was able
• 35:26to get sort of back
• 35:27of the envelope calculations,
• 35:29and nobody knows about it.
• 35:32Then there's the Risperdal
• 35:34case, which is the
• 35:36the antipsychotic crisis. My former
• 35:38colleagues love to talk about
• 35:39the opioid crisis being the
• 35:41worst public health disaster in
• 35:42American history
• 35:43with the exception of COVID.
• 35:45It's not the case. We're
• 35:47the antipsychotic
• 35:48crisis is much bigger, at
• 35:51least twice as big as
• 35:52opioids in terms of the
• 35:53number of deaths.
• 35:54And,
• 35:55and it was basically led
• 35:57by Johnson and Johnson, although
• 35:58there were five companies that's
• 36:00that were part of the
• 36:01the scam
• 36:02and sold atypical antipsychotics at
• 36:04the time, and all of
• 36:05them pleaded guilty to criminal
• 36:07charges.
• 36:08And the you know,
• 36:10just as they were launching
• 36:13Procrit, they
• 36:14Risperdal. I'm sorry. They there
• 36:16was a memo that basically
• 36:18said,
• 36:19look.
• 36:20The problem that we have
• 36:22is that we need to
• 36:23make a lot more money
• 36:25than we could possibly make
• 36:27with schizophrenia.
• 36:28The only approved use for
• 36:30Risperdal was in the schizophrenic
• 36:32mark was it amongst schizophrenics,
• 36:35but the anticipated growth of
• 36:36the antipsychotic market does not
• 36:38create enough room for the
• 36:39Risperdal sales forecast
• 36:41in North America.
• 36:43So we're gonna have to
• 36:44find a lot more patients
• 36:46facing a lot of other
• 36:48issues. And what they did
• 36:49is they came up with
• 36:51the sell to the symptoms,
• 36:54sales
• 36:55idea, which was basically
• 36:58schizophrenia
• 36:59leads to a whole host
• 37:01of problems. And, the the
• 37:03measure of schizophrenia is something
• 37:04called the PANSS scale, p
• 37:06a n. If if we
• 37:08have a psychiatrist here. He
• 37:10knows it better than I
• 37:10do.
• 37:12And and it's basically a
• 37:14listing of almost every
• 37:16mood or problem
• 37:18humans go through. And, of
• 37:19course, when you have schizophrenia,
• 37:21you go through them on
• 37:22a more intensive basis than
• 37:23almost anyone. And they include
• 37:25withdrawal, delusions, depression, and agitation.
• 37:28So
• 37:29they decided
• 37:30that they could sell,
• 37:32Risperdal
• 37:33for all of those,
• 37:35for all of those problems,
• 37:37depression, agitation, delusions, withdrawal. Anybody
• 37:39who knows even a little
• 37:40bit about the FDA,
• 37:42law and approval process knows
• 37:44that this is false. Like,
• 37:46you cannot, for instance, sell,
• 37:49antibiotics.
• 37:50You know, when you have
• 37:54a bacterial infection, you will
• 37:55often get a headache, but
• 37:57you know that you can't
• 37:58sell antibiotics as a treatment
• 38:00for all headaches. Like, that's
• 38:02just,
• 38:03you know, plain and simple
• 38:05stuff, but that's essentially what
• 38:07what Johnson and Johnson did
• 38:08with Risperdal.
• 38:10It was wildly illegal. They
• 38:12knew it from the start,
• 38:13and
• 38:14they then really used this
• 38:17to start targeting the elderly
• 38:19and children. And
• 38:21this drug was particularly dangerous
• 38:23in both those populations. The
• 38:25elderly, it killed them.
• 38:27And in children, it caused
• 38:29around ten percent of boys
• 38:31to develop breasts.
• 38:33They knew that this problem
• 38:35occurred. They kept this secret,
• 38:37and they pushed their sales
• 38:38force
• 38:39to to sell it as
• 38:41as aggressively impossible in the
• 38:43pediatric population,
• 38:44and even greater share, by
• 38:45the way, of girls
• 38:47would express milk,
• 38:50in their breasts. And if
• 38:51you've had a child,
• 38:53you will know that if
• 38:55your daughter suddenly starts expressing
• 38:57milk in her breasts,
• 38:59it is an appalling
• 39:00situation.
• 39:01They kept all of this
• 39:03secret
• 39:04because of this.
• 39:05You can see that this
• 39:06is sort of the total
• 39:08sales in two thousand,
• 39:09and the illegal sales,
• 39:12were about almost half of
• 39:15the total Risperdal sales.
• 39:17This is, you know,
• 39:19the the maximum I mean,
• 39:21they were making roughly
• 39:23seven billion dollars
• 39:25a year on this. So,
• 39:27you know,
• 39:28they
• 39:29they were making three billion
• 39:31dollars a year, which they
• 39:32did because they had, you
• 39:34know, various versions of Risperdal
• 39:36for nearly twenty years, they
• 39:37would eventually pay a two
• 39:39point two billion dollar
• 39:41fine for their, you know,
• 39:42their admitted
• 39:44crimes in doing this that
• 39:46led to more than a
• 39:48million deaths.
• 39:49But even they made that
• 39:51up in just one year
• 39:52of sales.
• 39:55Opioids. I I already told
• 39:57you my little wonderful little
• 39:59factoid about opioids that's that
• 40:02Johnson and Johnson you know,
• 40:03that that basically Purdue Pharma
• 40:05and the Sacklers were pikers
• 40:07compared to Johnson and Johnson
• 40:08in the market. Johnson and
• 40:10Johnson dominated the opioid market
• 40:12in the supplies.
• 40:13They also,
• 40:17they they were were the
• 40:19ones that
• 40:20invented fentanyl,
• 40:22and they created a fentanyl
• 40:24patch. And
• 40:25just as Purdue Pharma was,
• 40:29from two thousand one onward,
• 40:31everybody knew what Purdue Pharma
• 40:32was doing. But the opioid
• 40:34crisis continued to worsen. Why?
• 40:37Because
• 40:38even though everybody knew that
• 40:39Purdue Pharma were bad guys,
• 40:42the most admired
• 40:44corporation
• 40:45in the pharmaceutical
• 40:46space was repeating all those
• 40:48sales points.
• 40:49And Johnson and Johnson created
• 40:51the fentanyl patch, which
• 40:53it's hard to believe at
• 40:54this point. They marketed as
• 40:57nonaddictive.
• 40:58They said that fentanyl, unlike
• 41:00OxyContin,
• 41:02would not addict you. Now
• 41:03we all know now that
• 41:05fentanyl is actually
• 41:06seventy five times more powerful
• 41:09and more addictive
• 41:11than traditional opioids.
• 41:12But at the time,
• 41:14remarkably,
• 41:15Johnson and Johnson was able
• 41:17to
• 41:18make this claim stick
• 41:20in the marketplace.
• 41:21And so
• 41:23Johnson and Johnson is actually
• 41:25the the sort of the
• 41:26drug kingpin of the opioid
• 41:27crisis in the United States,
• 41:29not Purdue Pharma.
• 41:32Pinnacle,
• 41:33you know, I I I
• 41:34wanted to go into medical
• 41:35devices.
• 41:36Pinnacle,
• 41:37was this metal metal hip
• 41:39implant that Johnson and Johnson
• 41:41created.
• 41:43There there had been an
• 41:44earlier generation of medical,
• 41:47of metal metal hip implants
• 41:48that had failed and failed
• 41:50spectacularly.
• 41:51Johnson and Johnson told the
• 41:52FDA that theirs would be
• 41:54different because they have this
• 41:55tiny,
• 41:57gap between the the femoral
• 42:00head and that metal insert
• 42:01there.
• 42:02But in fact, they
• 42:04fairly quickly realized they they
• 42:06had to widen the gap
• 42:08to to be just as
• 42:09wide as the earlier generation.
• 42:11They lied to the FDA
• 42:13about
• 42:14about this in their in
• 42:15their application even though the
• 42:17application
• 42:18included
• 42:19having to sign a sworn
• 42:21statement
• 42:22that the descriptions of the
• 42:23device were all accurate.
• 42:26And then I I wanted
• 42:27to include some of these
• 42:28records just because this is
• 42:30a medical school. As you
• 42:31know, there are
• 42:33ethical rules about human research
• 42:35that are near sacred in
• 42:37this hospital and elsewhere.
• 42:39You have to get IRB
• 42:41ethic committee approval before you
• 42:44go forward.
• 42:45You have to get patient
• 42:47consent.
• 42:47They you have to have,
• 42:49you know, a description of
• 42:50the risks, and you have
• 42:51to have patients sign these
• 42:52consent forms. You have to
• 42:54collect the data accurately. Johnson
• 42:56and Johnson broke
• 42:57every single one of these
• 42:58rules even though their internal
• 43:01ethics document
• 43:02had on its front cover
• 43:04the Nuremberg trials
• 43:06where the these Nazi doctors
• 43:08were prosecuted for violating all
• 43:10of these rules.
• 43:11And the suggestion was if
• 43:13you violate any of these
• 43:14rules, you're a Nazi.
• 43:16Johnson and Johnson violated them
• 43:18all. This is a this
• 43:19is a you can sort
• 43:20of see
• 43:21the release of medical records.
• 43:23They had a different study
• 43:24there, and then, you know,
• 43:26post hoc, someone
• 43:29writes in by hand that
• 43:30it's the pinnacle hip study.
• 43:33Here's a a letter from
• 43:35the head of the study
• 43:36to one of the study
• 43:37investigators.
• 43:38We're gonna need a signed
• 43:40medical release form and component
• 43:42labels numbers for each of
• 43:43these patients
• 43:44as soon as you're able
• 43:45to obtain them. In other
• 43:47words, you know, this is
• 43:48post hoc. You
• 43:50you've gotta sign these release
• 43:51forms before you're in the
• 43:53study, not afterward.
• 43:55This guy, Steven Lancaster from,
• 43:57from Florida,
• 43:59Jacksonville,
• 44:00Florida,
• 44:01his IRB found out that
• 44:03he was doing this study.
• 44:04They sent him a letter
• 44:06saying
• 44:07because IRC approval, the,
• 44:09IRB, their internal
• 44:11review board had had never
• 44:13been granted, this is a
• 44:14direct violation of Baptic Medical
• 44:16Center,
• 44:17IRC, an OHRP,
• 44:19Office of Human Research Protection
• 44:21policy.
• 44:21They basically,
• 44:23threatened him with prosecution.
• 44:25He then writes back saying,
• 44:27well, if you if you're
• 44:28gonna be this way, I'm
• 44:30gonna drop this study. I
• 44:31no longer desire to participate
• 44:33in in any participation in
• 44:35this study. He copied Johnson
• 44:37and Johnson as did the
• 44:38IRB
• 44:39and then sends a letter,
• 44:41you know, a few months
• 44:42later saying,
• 44:44well, you know, the storm
• 44:46has passed from the IRB.
• 44:48I assume it's okay for
• 44:50me to continue to participate
• 44:51in this study
• 44:52and continue to send you
• 44:55updates on on past and
• 44:57new patients.
• 44:59So he lies to his
• 45:00IRB. This guy, by the
• 45:01way, is continuing to practice
• 45:02medicine.
• 45:03He lies to it. If
• 45:04the IRB finds out about
• 45:06this study, He swears to
• 45:08the IRB that he's not
• 45:09gonna do it, and then
• 45:10he continues to
• 45:12participate in the study without
• 45:14any patient consents.
• 45:16And, in fact, most of
• 45:17the patients in this study
• 45:19never had IRB approval,
• 45:22any IRB oversight,
• 45:23or any patient consents,
• 45:27and and the result was
• 45:29utter disaster for the patients.
• 45:30You can see what happened
• 45:32in these metal on metal
• 45:33hip inpatient.
• 45:35They they basically
• 45:36this device basically melted,
• 45:39the the the hips, the
• 45:41bones, the muscle, everything
• 45:44of these patients
• 45:45because
• 45:46the metal the metal,
• 45:49rubbed on the other metal,
• 45:50creating this
• 45:52toxic cloud of metal ions
• 45:54that then poisoned
• 45:55not only the surrounding tissue,
• 45:57but caused heart attacks,
• 45:59caused brain
• 46:01problems for these patients. It
• 46:03is among the largest disasters
• 46:06in
• 46:06orthopedic history.
• 46:09Then there's the vaginal mesh
• 46:10case, which, you know, is
• 46:12almost,
• 46:14an afterthought.
• 46:16In Australia, by the way,
• 46:17vaginal mesh became a huge
• 46:19national scandal.
• 46:20And, basically, Johnson and Johnson
• 46:23did a study of this
• 46:24vaginal mesh.
• 46:25The study failed all of
• 46:27its endpoints because
• 46:28more than a quarter of
• 46:29the women who got this
• 46:31device
• 46:32actually,
• 46:34had disastrous
• 46:36results.
• 46:37This this happened to hundreds
• 46:39of thousands of women
• 46:40that this this device, which
• 46:42was this mesh, was put
• 46:44around their
• 46:45vaginas.
• 46:46The the plastic mesh then
• 46:48intruded into their vaginal walls,
• 46:50made it impossible for them
• 46:52ever to have vaginal sex
• 46:53again.
• 46:54They ended up dripping blood
• 46:57all the time.
• 46:59They could never wear skirts
• 47:01again,
• 47:02always had to wear pants
• 47:03with
• 47:04padding down there.
• 47:06Johnson and Johnson knew that
• 47:08this was gonna happen. And
• 47:09in this case, they didn't
• 47:10lie to the FDA about
• 47:11it. They just didn't bother
• 47:13even getting approval from the
• 47:14FDA. They just started selling
• 47:16this device around the world
• 47:19knowing that it was going
• 47:20to ruin the lives of
• 47:22hundreds of thousands of women.
• 47:24And, you know,
• 47:26here's an internal,
• 47:28document that's
• 47:29that talks about their despite
• 47:31the failure of their own
• 47:33study, they sold it because
• 47:35failure doesn't mean failure, I
• 47:36guess.
• 47:38The book has gotten a
• 47:39lot of nice reception. It
• 47:41was chosen by the National
• 47:42Books Critics Circle as a
• 47:44best of twenty twenty five
• 47:46Financial Times. The Los Angeles
• 47:48Times just announced
• 47:49several hours ago that it's
• 47:50one of their top picks
• 47:51for twenty twenty five, and
• 47:53Amazon picked it as the
• 47:54best book,
• 47:56as the best nonfiction book
• 47:57of twenty twenty five.
• 47:59Let's talk a little bit
• 48:00about solutions.
• 48:01In a medical school like
• 48:02this, my
• 48:04fervent hope
• 48:05is that you start doing
• 48:07some epidemiology
• 48:08studies. Joe knows I called
• 48:10around
• 48:11to every
• 48:13epidemiologist
• 48:14I know
• 48:15while during the five years
• 48:16that I was doing this
• 48:17book and begged people to
• 48:19do these studies.
• 48:20And
• 48:22I am still stunned at
• 48:24how little success I add.
• 48:26The antipsychotic
• 48:28crisis
• 48:29is the
• 48:32most expensive
• 48:34is is the largest, costliest,
• 48:37and deadliest criminal conspiracy in
• 48:39American history. Nothing else is
• 48:41close.
• 48:42I called,
• 48:44there's two experts on the
• 48:46effects of antipsychotics
• 48:48in the elderly who've done
• 48:50most of the publications on
• 48:51this side. One of them
• 48:53is an old friend. I
• 48:54called this person and said,
• 48:55you know, my back of
• 48:56the envelope calculation
• 48:58is that about a million
• 48:59people have died. Can that
• 49:01be right? And this person
• 49:02said, oh, no. No. No,
• 49:03Gordon. I think you're way
• 49:04off. And I was like,
• 49:04oh, well, is it five
• 49:05hundred thousand, two hundred and
• 49:06fifty thousand?
• 49:07And this person said, no.
• 49:09And I think it's about
• 49:09six times the number you
• 49:11said. And I said, wait.
• 49:14You think six million Americans
• 49:16have died from this?
• 49:18Give or take about a
• 49:19million? Yeah.
• 49:20And again, I said, and
• 49:22you didn't think that
• 49:24you should
• 49:25publish on this? And this
• 49:27person said, do you know
• 49:28what kind of lawyers these
• 49:29guys have? Which is a
• 49:30response that I get to
• 49:33this day.
• 49:34One of the top public
• 49:35health podcasts in this country
• 49:38is run by a friend
• 49:39of mine.
• 49:40This person called me up,
• 49:41wanted to get me on,
• 49:42and called me up a
• 49:43few weeks ago and said,
• 49:44Garner, the lawyers just won't
• 49:46let me talk to you.
• 49:48You know, Johnson and Johnson
• 49:49has spent thirty five billion
• 49:51dollars on litigation expenses since
• 49:54two thousand and thirteen.
• 49:55I like to say that
• 49:56it's based Johnson and Johnson
• 49:58is basically a law firm
• 49:59with a drug and a
• 50:00device company attached to it.
• 50:03And and throughout the time
• 50:05that I did this,
• 50:07I cannot tell you the
• 50:08number of people who said
• 50:09to me, Gardner, you're out
• 50:10of your mind. They will
• 50:12come after you, and they
• 50:13will never stop.
• 50:16So,
• 50:17like,
• 50:18let's
• 50:19please, somebody
• 50:20do the epidemiology
• 50:22on antipsychotics.
• 50:23It's not that hard.
• 50:25The,
• 50:26you know, the Medicare database
• 50:28will tell you how many
• 50:29people have it, have gotten
• 50:31these drugs in nursing home
• 50:33settings.
• 50:34The hazard ratios
• 50:35have are widely known.
• 50:38The I don't like, I'm
• 50:39not an epidemiologist, but I
• 50:41don't think the estimates can
• 50:42be all that hard. Same
• 50:43thing with EPO.
• 50:45Obviously,
• 50:47another thing I talk about
• 50:49in the book is
• 50:50we have to stop letting
• 50:52physicians
• 50:53be
• 50:54part time drug sales reps.
• 50:57Like, it's fairly simple.
• 50:58Like, in no other industry
• 51:00would you let the people
• 51:02who are
• 51:03buying something
• 51:05be paid by the suppliers.
• 51:07None of the disasters I
• 51:08talk about in these books
• 51:10in in my book really
• 51:11happened in Europe because doctors
• 51:13cannot take money from drugmakers
• 51:15in Europe.
• 51:16So there is no opioid
• 51:18crisis. Never has been an
• 51:19opioid crisis in Europe. There
• 51:21is no antipsychotic
• 51:22crisis.
• 51:23None of these things have
• 51:24happened
• 51:25because
• 51:26you cannot corrupt medicine in
• 51:28Europe the way you can
• 51:29in the United States.
• 51:32Another thing we talked about
• 51:33here is that, you know,
• 51:35in aviation, there's the FAA,
• 51:38but when mistakes happen, the
• 51:40NTSB,
• 51:41National Transportation
• 51:42Safety Board, comes in and
• 51:43investigates.
• 51:44The understanding being the FDA
• 51:46the FAA
• 51:47approved these planes, and they
• 51:48have a conflict of interest,
• 51:50and they can investigate
• 51:51when they go wrong.
• 51:53The FDA
• 51:54does not really care
• 51:56about what happens to products
• 51:58once the the FDA approves
• 52:00them. And this has been
• 52:01shown again and again and
• 52:03again, and I had friends
• 52:05who were epidemiologists
• 52:06at the at the FDA
• 52:07and basically were locked in
• 52:09the basement.
• 52:11The FDA did not want
• 52:13they would did not want
• 52:14me as a reporter to
• 52:16ever talk to those people,
• 52:17and those people were not
• 52:19allowed essentially
• 52:21to tell the world what
• 52:22they found about
• 52:24various drugs and devices.
• 52:26And then I also think
• 52:27we were talking about this
• 52:28before.
• 52:30You know,
• 52:31I think
• 52:33Yale Business School could do
• 52:35could have more studies about
• 52:38for profit health care and
• 52:40how it works or doesn't
• 52:42work. I think Yale could,
• 52:44you know, start a start
• 52:46Yale in Copenhagen to sort
• 52:47of show,
• 52:49you know,
• 52:51different
• 52:52health care systems and how
• 52:54they work and how they
• 52:55don't work. I think there's
• 52:57a lot that academia could
• 52:58do that could help in
• 53:00these things.
• 53:02And that's it.
• 53:04And so thank you.
• 53:23Wow.
• 53:24Well, that was,
• 53:26like I said, morally
• 53:28outrageous. Injurious.
• 53:30Yeah.
• 53:31Thank you so much for
• 53:32all of your work and
• 53:33for sharing everything. So we're
• 53:34gonna turn it to
• 53:36the room for questions.
• 53:39Who's the brave person who's
• 53:40gonna go first.
• 53:44Bree.
• 53:47First of all, thank you
• 53:47so much. That was really
• 53:48great. I've actually spent the
• 53:49last three weeks listening to
• 53:50your audio book on my
• 53:51run, so it's really cool
• 53:52to, like, get a face
• 53:53to,
• 53:54to the voice I've been
• 53:55listening to for a while.
• 53:58The book and the talk
• 53:59I think were incredibly frustrating,
• 54:01terrifying,
• 54:02exhausting.
• 54:03I'm sure other people here
• 54:05have read the book and
• 54:06also felt that way. But
• 54:07I was really curious, I
• 54:09have infinite questions,
• 54:11but
• 54:12one quite broad one is,
• 54:12what was the pushback that
• 54:14you experienced
• 54:15in this? I mean, you
• 54:16just said that you have
• 54:17people that would love to
• 54:18talk to you on podcast
• 54:19but are told that they
• 54:20can't. Obviously,
• 54:22as you're doing research, it
• 54:23becomes very clear to people
• 54:24that you're digging into this
• 54:25kind of thing.
• 54:26How was that experience? You
• 54:28said it took you five
• 54:28years. Was that Yeah. Yeah.
• 54:30What was that experience?
• 54:32So there was pushback while
• 54:33I was doing it.
• 54:37You know, I
• 54:39spent a lot of time
• 54:40trying to get Johnson and
• 54:42Johnson to engage with me.
• 54:43They
• 54:44didn't I had this
• 54:46sort of Chinese water torture
• 54:49thing with them where I,
• 54:50you know, I called hundreds
• 54:52of their executives and former
• 54:54executives because I had these
• 54:57employee rosters from
• 54:59these,
• 55:00these grand jury files, and
• 55:01it must have driven them
• 55:03nuts, You know, because,
• 55:05only ten percent of people
• 55:07would really talk to me.
• 55:08And, you know, the other
• 55:09ninety percent, I'm sure, called
• 55:11up corporate and said, this
• 55:13guy just called me. Like,
• 55:14do you guys know? And,
• 55:16so
• 55:19I think what was
• 55:21kind of disappointing
• 55:22to me was the lack
• 55:25of courage,
• 55:26in amongst my academic friends
• 55:29to kind of help me
• 55:30and
• 55:30or even discuss this a
• 55:32lot of these things on
• 55:33the record,
• 55:35because Johnson and Johnson is
• 55:37such a huge funder of
• 55:39academic medical centers. And,
• 55:42and I and there's also
• 55:43a worry that the Robert
• 55:45Wood Johnson Foundation, which is
• 55:47the largest health care foundation
• 55:48in the United States in
• 55:49terms of funding
• 55:51health care,
• 55:52would frown on this. I
• 55:53can tell you that I've
• 55:55since been in conversation with
• 55:56the Robert Wood Johnson Foundation.
• 55:58They're now doing this truth
• 55:59and reconciliation
• 56:00effort as a result of
• 56:01my my book. They've now
• 56:03divested themselves entirely of Johnson
• 56:05and Johnson stock. They used
• 56:06to be the largest
• 56:08owner of Johnson and Johnson
• 56:09stock. So they are trying
• 56:11to figure out a way
• 56:12to tell academia that they
• 56:14are not Johnson and Johnson
• 56:16and would not be upset
• 56:18if people engaged with these
• 56:20issues.
• 56:20Once the book has come
• 56:22out,
• 56:23the company is you know,
• 56:24we really
• 56:26I I wanna give credit
• 56:27to Random House. They were
• 56:28brave enough to to publish
• 56:30this book. I will tell
• 56:31you that Random House's foreign
• 56:32subsidiaries
• 56:34are not. It is not
• 56:36published in England. It is
• 56:37not published in much of
• 56:38the world
• 56:39because, as you know, libel
• 56:41laws in the rest of
• 56:42the world are not as
• 56:43strong as they are here.
• 56:45So,
• 56:46and, you know, a lot
• 56:48of places just sort of
• 56:50have refused to discuss it.
• 56:51I told you about this
• 56:52podcast. Even my publication, The
• 56:54New York Times, got very
• 56:56nervous about this. I never
• 56:57got
• 56:58I'm the only book that
• 57:00is on NBCC you know,
• 57:02the National Book Critics Circle
• 57:04best of twenty five twenty
• 57:06five.
• 57:06Mine is the only book
• 57:08on that list, on the
• 57:09Financial Times list, on the
• 57:11Los Angeles Times list that
• 57:12was not reviewed by the
• 57:14New York Times
• 57:15and was not reviewed in
• 57:17a lot like, if you
• 57:18go through the list, you
• 57:20will find
• 57:21that in many of these
• 57:22publications, I get on their
• 57:24best of twenty twenty five
• 57:25list. I was I I'm
• 57:27the only one on there
• 57:28that was not reviewed.
• 57:30So there is still to
• 57:32this day a lot of
• 57:33fear,
• 57:34of this company and its
• 57:35lawyers, and there's a good
• 57:37reason. These guys
• 57:39have some of the toughest
• 57:40lawyer. You know, they
• 57:42basically have almost every major
• 57:44corporate law firm in the
• 57:45country
• 57:47on their roster, and it
• 57:48includes former FBI directors and
• 57:50the rest.
• 57:52Almost every major corporate lawyer,
• 57:54if you ask them if
• 57:55they've represented Johnson and Johnson,
• 57:57will say
• 58:05yes. Hi. Thank you so
• 58:06much for the talk.
• 58:08I think right now, there's
• 58:10a lot of
• 58:12rightful concern
• 58:13among
• 58:14medical and public health professionals
• 58:16that sometimes
• 58:17our work gets cast in
• 58:20a negative light unfairly for
• 58:21relations with pharma companies
• 58:23in this administration, particularly notably
• 58:26with vaccine manufacturers and vaccine
• 58:28developers.
• 58:29And so how do you
• 58:30suggest that
• 58:31we walk the line between
• 58:34where
• 58:35we really do need to
• 58:36engage with pharma companies in
• 58:38vaccine development and distribution,
• 58:41for the good of patients?
• 58:42How do we communicate to
• 58:43patients? What ethical relationships look
• 58:46like and not and at
• 58:48the same time, not encourage
• 58:50corrupt practices?
• 58:52So I think they're
• 58:54like, at places like Yale,
• 58:55I think you could
• 58:57instead of having direct
• 58:59consulting relationships between the professor
• 59:02and
• 59:02the company, you could cycle
• 59:04it through the hospital or
• 59:06the department or something.
• 59:08And, you know, I think
• 59:09that there are ways to
• 59:10have these relationships
• 59:12where there's some real protection,
• 59:14where, you know, Jennifer can
• 59:16be involved in the committee
• 59:18that is accepting the monies
• 59:20from these companies
• 59:21and others here,
• 59:23and that there is some
• 59:24oversight. I'd love to hear
• 59:25from you, Joe. You've been
• 59:27working in this area for
• 59:29a long time, and I
• 59:30think that they're you know,
• 59:32I think the real problems
• 59:34are really in clinical medicine
• 59:36where so much of this
• 59:38bad behavior happens. So many
• 59:40of these studies
• 59:41are not real studies. They're
• 59:43just seeding trials. They're marketing
• 59:44studies.
• 59:45That that one where I
• 59:46said where they were,
• 59:48monkeying with the disclosures, that
• 59:50that was simply because it
• 59:52was,
• 59:53it was being run by
• 59:54the marketing department,
• 59:56of J and J, not
• 59:57by the science department.
• 60:00I wanna say that
• 01:00:03in this time,
• 01:00:05it's it's
• 01:00:06it is not
• 01:00:08science's
• 01:00:09fault that science is being,
• 01:00:12you know,
• 01:00:14pushed aside. I I think
• 01:00:16there's a lot of scam
• 01:00:17artists who love the notion
• 01:00:19that everyone is wrong equally.
• 01:00:22I don't think that's true,
• 01:00:24and I don't think it's
• 01:00:25your fault. Having said that,
• 01:00:28I think,
• 01:00:30the side the side of
• 01:00:31science needs to do a
• 01:00:32better job,
• 01:00:34admitting its mistakes, cleaning up
• 01:00:36its act.
• 01:00:37I think there were real
• 01:00:39problems, and I,
• 01:00:41I don't talk about this
• 01:00:42all that much, but I
• 01:00:43wrote the Biden administration's
• 01:00:45COVID nineteen testing plan for
• 01:00:47them. I was engaged at
• 01:00:48the highest levels of the
• 01:00:49highest levels
• 01:00:50of the COVID nineteen response,
• 01:00:52and we made some really
• 01:00:54bad mistakes.
• 01:00:55And,
• 01:00:56we never have really acknowledged
• 01:00:58that.
• 01:00:59And I think it would
• 01:01:00go a long way if
• 01:01:02we did. It's clear in
• 01:01:04retrospect that schools,
• 01:01:06particularly in blue states, were
• 01:01:08closed for far too long.
• 01:01:10It is clear that mask
• 01:01:12mandates
• 01:01:13should not have continued as
• 01:01:14long as they did in
• 01:01:15elementary schools. Like, there are
• 01:01:18all kinds of occupational studies
• 01:01:20that show that people cannot
• 01:01:21wear masks
• 01:01:22effectively for more than two
• 01:01:24hours. There was no way
• 01:01:27a second grader was gonna
• 01:01:28be able to wear a
• 01:01:29mask
• 01:01:30all day at school in
• 01:01:31a way that would genuinely
• 01:01:33be protective.
• 01:01:34And yet, you know, public
• 01:01:36health authorities really push that
• 01:01:38stuff, and it and I
• 01:01:39don't think it was in
• 01:01:41retrospect
• 01:01:42right.
• 01:01:43That's schools never became vectors
• 01:01:45of transmission in communities.
• 01:01:47We have to acknowledge that,
• 01:01:48and so we don't do
• 01:01:49it again. And I think
• 01:01:50it would add a lot
• 01:01:52of credibility
• 01:01:53to the public health side
• 01:01:55in red states.
• 01:01:57So
• 01:01:58having said that, it ain't
• 01:01:59our fault. You know, the
• 01:02:01attack on science is real.
• 01:02:03It it's it's toxic, and
• 01:02:05we need to be unapologetic
• 01:02:07about
• 01:02:08advocating for real science and
• 01:02:10things like childhood vaccines.
• 01:02:16Hi. Thanks for a really
• 01:02:17interesting talk. Yeah.
• 01:02:19Depressing.
• 01:02:21Are there are there similar
• 01:02:22books to be written about
• 01:02:24Lilly, Merck, Pfizer, AbbVie?
• 01:02:27So this is the question
• 01:02:28that I really struggled with.
• 01:02:31I'll just tell a brief
• 01:02:32story about I have the
• 01:02:34grand jury files for the
• 01:02:35Risperdal case. I have the
• 01:02:36grand jury files for the
• 01:02:37Zyprexa case, both antipsychotics.
• 01:02:41Johnson and Johnson, the head
• 01:02:43of the Risperdal marketing program
• 01:02:45was this guy, Alex Gorski,
• 01:02:47who John they while they
• 01:02:50Johnson and Johnson was negotiating
• 01:02:51its guilty plea and this
• 01:02:53two point two billion dollar
• 01:02:55fine for
• 01:02:57Al Skorsky's
• 01:02:59actions,
• 01:03:00they decided to make him
• 01:03:01their CEO. Al Skorsky also,
• 01:03:04by the way, is arguably
• 01:03:06the
• 01:03:07greatest cause of the opioid
• 01:03:09crisis in the United States.
• 01:03:10At Eli Lilly, there was
• 01:03:12a guy named Michael Bendick
• 01:03:13who was in charge of
• 01:03:15their Zyprexa marketing program
• 01:03:17and was the guy in
• 01:03:19charge
• 01:03:20of the crimes that Eli
• 01:03:21Lilly admitted to.
• 01:03:23When they discovered they were
• 01:03:25be investigated
• 01:03:26for for these crimes, they
• 01:03:28called him into,
• 01:03:30a,
• 01:03:31a conference room. They read
• 01:03:33him,
• 01:03:34from a script, and they
• 01:03:36gave him ten minutes to
• 01:03:37clear out his desk and
• 01:03:39either be fired
• 01:03:40or resign on the spot.
• 01:03:43So Lilly
• 01:03:45acknowledged its mistake, paid an
• 01:03:47even larger fine, and fired
• 01:03:49the guy associated with it.
• 01:03:50Johnson and Johnson
• 01:03:52made that guy their CEO.
• 01:03:54So I I do I
• 01:03:56knew all of the CEOs
• 01:03:57of all of the pharma
• 01:03:58companies.
• 01:04:00All of these companies have
• 01:04:01very different characters.
• 01:04:03I think Johnson and Johnson
• 01:04:04is by far the worst
• 01:04:05of the worst. I'm not
• 01:04:06saying
• 01:04:07there are some bad other
• 01:04:09companies.
• 01:04:10The industry itself
• 01:04:11has caused
• 01:04:13more crime
• 01:04:14and and caused more death
• 01:04:16than any other in American
• 01:04:17history. Jennifer has done this
• 01:04:19extraordinary job, really,
• 01:04:21of doing this pharma scorecard
• 01:04:23for the last ten years
• 01:04:25that I think is incredibly
• 01:04:27helpful
• 01:04:28and has seemed to,
• 01:04:31trouble this industry
• 01:04:32in a way that even
• 01:04:34something like my book has
• 01:04:35done. Although, I will tell
• 01:04:36you one of the more
• 01:04:37fun things. You know, we're
• 01:04:38all on LinkedIn.
• 01:04:40You know how you get
• 01:04:41these reports once a week
• 01:04:42about the people who have
• 01:04:43looked in your LinkedIn profile.
• 01:04:45And I like, every week,
• 01:04:46I get, like, a hundred
• 01:04:48and fifty people from Johnson
• 01:04:49and Johnson that looked at
• 01:04:50your profile.
• 01:04:51And it's always like, all
• 01:04:52these recruiters from Johnson and
• 01:04:54Johnson, like, you should really
• 01:04:56consider going for a job
• 01:04:57at Johnson and Johnson. You
• 01:04:58know? They're really interested in
• 01:05:00you.
• 01:05:01But, no, I think there
• 01:05:02are some good companies, mostly
• 01:05:04the European companies, because they
• 01:05:06operate in a very different
• 01:05:07system
• 01:05:08that kind of creates a
• 01:05:09different set of incentives.
• 01:05:13And there are some bad
• 01:05:14companies. I think, obviously, Johnson
• 01:05:16and Johnson is at bottom
• 01:05:17of the barrel, but there
• 01:05:18are a couple down there
• 01:05:19with them.
• 01:05:22Hey, Joe. Hey,
• 01:05:27Got it. Got
• 01:05:28it. Got it. Yeah.
• 01:05:31Garnet, just amazing. I mean,
• 01:05:32just an amazing book and
• 01:05:33amazing
• 01:05:35investigative journalism that covers,
• 01:05:37like, so much time. I'm
• 01:05:38sure everyone in the audience
• 01:05:39was as
• 01:05:41overwhelmed as I am. I
• 01:05:42mean, that's must be part
• 01:05:43part of the hardest
• 01:05:45one of the hardest parts
• 01:05:46about delivering the talk. So
• 01:05:48you're covering so much ground.
• 01:05:50Right.
• 01:05:51I I'm curious. Well, a
• 01:05:52couple of things. One,
• 01:05:54why
• 01:05:56do you think Johnson and
• 01:05:57Johnson has been
• 01:05:59particularly bad? Why are there
• 01:06:01so many sort of skeletons
• 01:06:03in their closet? Because,
• 01:06:04you know, twenty years ago,
• 01:06:06when we first met, right,
• 01:06:07a lot of things were
• 01:06:09coming out around companies being
• 01:06:10led by marketing executives Yeah.
• 01:06:12Kind of corners that were
• 01:06:13cut, harms that were caused.
• 01:06:15Sure.
• 01:06:16And is it so I'm
• 01:06:18I'm curious whether the conglomerate
• 01:06:20at nature, which perhaps created
• 01:06:21competition among
• 01:06:23the divisions Yeah. Led to
• 01:06:24this in some ways as
• 01:06:26and with that with few
• 01:06:28kind of overarching controls over
• 01:06:29them. Yeah.
• 01:06:31But the other thing I'm
• 01:06:32really curious about is,
• 01:06:34you know, when we started
• 01:06:36to working on some of
• 01:06:37these issues twenty years ago
• 01:06:38Right. We were able to
• 01:06:39get a number of things
• 01:06:41pushed forward and changed. Yeah.
• 01:06:43Some of it ethical around
• 01:06:44the sort of the expectations
• 01:06:46and conduct and what physicians
• 01:06:47and other clinicians should be
• 01:06:48doing. Joe and I have
• 01:06:49been working together for, like,
• 01:06:50since, you know, God was
• 01:06:52young, essentially,
• 01:06:53on a lot of this
• 01:06:54stuff. Yeah. Like clinical trial
• 01:06:56registration Yeah.
• 01:06:58Understanding around, like,
• 01:07:00among the journals around see
• 01:07:01what seating trials are Yeah.
• 01:07:03Authorship requirements,
• 01:07:04you know, all all of
• 01:07:05these
• 01:07:06different issues.
• 01:07:08How many of the
• 01:07:11the scandals, for lack of
• 01:07:12a better term,
• 01:07:14would have been prevented by
• 01:07:15those,
• 01:07:17actions? The the opioid,
• 01:07:19sort of crisis aside. Because
• 01:07:20it feels like a lot
• 01:07:21of those things
• 01:07:22did happen before, but maybe
• 01:07:24that's my own misunderstanding.
• 01:07:26Yeah. And maybe they wouldn't
• 01:07:27have been. Like, I'm just
• 01:07:28trying to think of, like,
• 01:07:28how do how do we
• 01:07:29stop this from happening in
• 01:07:30the future? So Jennifer and
• 01:07:31I were just talking about
• 01:07:32this.
• 01:07:34I I don't
• 01:07:37the first part of your
• 01:07:38question,
• 01:07:39like The conglomerates. Oh, the
• 01:07:40conglomerate. So I
• 01:07:42came up with a variety
• 01:07:43of theories about why Johnson
• 01:07:45and Johnson is so
• 01:07:46completely toxic or the worst
• 01:07:48of the worst. One is
• 01:07:49the family of companies where,
• 01:07:52Johnson and Johnson basically
• 01:07:54has something like a hundred
• 01:07:55and forty different subsidiaries,
• 01:07:57and
• 01:07:58it's,
• 01:07:59creates this kind of almost
• 01:08:01hunger games amongst the
• 01:08:04subsidiaries
• 01:08:04where they have to make
• 01:08:06their numbers or the subsidiary
• 01:08:08goes away, and all of
• 01:08:09the people in the subsidiary
• 01:08:11have to reapply for their
• 01:08:12jobs.
• 01:08:13So it sets up this
• 01:08:15incentive structure
• 01:08:16that you might as well
• 01:08:18kind of aim for the
• 01:08:19stars because you're gonna get
• 01:08:21your head cut off anyway.
• 01:08:23So and and they do
• 01:08:25they never punish people for
• 01:08:27bad behavior.
• 01:08:28All the executives
• 01:08:29all all those documents that
• 01:08:31I showed, the executives that
• 01:08:32were behind
• 01:08:33the fake
• 01:08:35studies, the, you know, not
• 01:08:37having IRBs, all those executives
• 01:08:39got promoted. Like, not a
• 01:08:41single one of them was
• 01:08:43ever fired for unethical conduct.
• 01:08:45So you're gonna be fired
• 01:08:47if you don't make your
• 01:08:48numbers.
• 01:08:49You're not gonna be fired
• 01:08:50if
• 01:08:51you break the law and
• 01:08:54hit your numbers. And in
• 01:08:55fact, Alex Gorski
• 01:08:56has given multiple speeches where
• 01:08:58he says, you know, the
• 01:09:00first thing you have to
• 01:09:00do is make your numbers.
• 01:09:02So I I think the
• 01:09:03conglomerate thing is a is
• 01:09:05a big one.
• 01:09:06I think also,
• 01:09:09oddly enough, the creation of
• 01:09:10the Robert Wood Johnson Foundation,
• 01:09:12I think, is is simultaneous
• 01:09:15with Johnson and Johnson turning
• 01:09:17very dark. Because what happened
• 01:09:19is more than a third
• 01:09:20of the shares of Johnson
• 01:09:21and Johnson were put into
• 01:09:22this foundation.
• 01:09:24Johnson and Johnson executives were
• 01:09:25put on the board. They
• 01:09:26essentially controlled
• 01:09:28their own shares.
• 01:09:30And so that
• 01:09:32that feedback mechanism with Wall
• 01:09:34Street or oversight from Wall
• 01:09:35Street essentially in the seventies,
• 01:09:37eighties, and nineties
• 01:09:38was not there for Johnson
• 01:09:40and Johnson. So, oddly, even
• 01:09:41though the Robert Wood Johnson
• 01:09:43Foundation is seen
• 01:09:44as this great thing,
• 01:09:47I think, arguably,
• 01:09:48it really turned
• 01:09:50Johnson and Johnson dark. And
• 01:09:51then then finally, I think
• 01:09:53two other things. Johnson's baby
• 01:09:54powder,
• 01:09:56as I talk about in
• 01:09:57the book, is the most
• 01:09:59extraordinary
• 01:10:00branding tool ever. Right? Because
• 01:10:02what hap it's the most
• 01:10:03recognized
• 01:10:04scent in the world. Their
• 01:10:05own survey show this. And
• 01:10:07as you guys know,
• 01:10:11smell and memory
• 01:10:12are are are right next
• 01:10:14to each other in the
• 01:10:15brain. You know, if you
• 01:10:16there's all kinds of French
• 01:10:17poetry about how, you know,
• 01:10:19it smell is the most
• 01:10:20evocative.
• 01:10:21And, like, if you if
• 01:10:23you suddenly smell a smell
• 01:10:24from your childhood,
• 01:10:26that entire world will suddenly
• 01:10:28appear before your mind's eye.
• 01:10:30And so what has what
• 01:10:31happened for more than half
• 01:10:33of American babies is this
• 01:10:35iconic smell
• 01:10:37was embedded in their brain
• 01:10:39with the best thing that
• 01:10:40happened to them, which was
• 01:10:42their mom coming to them
• 01:10:43and cooing over them and
• 01:10:45wiping the their bottom of
• 01:10:47this terrible thing. Right? So
• 01:10:50from day one, you associate
• 01:10:52this smell with the best
• 01:10:54thing that happened to you.
• 01:10:55And for decades,
• 01:10:57every speech that Johnson and
• 01:10:58Johnson executives gave would start
• 01:11:00with, when I say Johnson's
• 01:11:02baby powder, how many of
• 01:11:04you can just smell it?
• 01:11:05And the entire room would
• 01:11:07just go,
• 01:11:08and and and it was
• 01:11:10like they were hypnotized.
• 01:11:12And so the comp Johnson's
• 01:11:14baby powder and then their
• 01:11:17their claim to this great
• 01:11:19conduct,
• 01:11:20in nineteen eighty two, which
• 01:11:22led their chief executive at
• 01:11:24the time to get the
• 01:11:25the presidential
• 01:11:26award of freedom, the highest
• 01:11:28civilian honor. The notion that
• 01:11:30they were very ethical in
• 01:11:32that, and Johnson's baby powder
• 01:11:34essentially served as Teflon
• 01:11:36for all of these problems.
• 01:11:37The reason I decided to
• 01:11:38do all, you know, all
• 01:11:40of these products and my
• 01:11:42original main script, by the
• 01:11:43way, was twice as long.
• 01:11:44I had a whole bunch
• 01:11:45more products. And my editor
• 01:11:46was just like, stop.
• 01:11:49The reason I wanna do
• 01:11:50all of them is that
• 01:11:51I did some of these
• 01:11:52stories at the times, and
• 01:11:53people would say, oh, well,
• 01:11:54you know, they might have
• 01:11:55made a mistake here, but
• 01:11:56it was such a great
• 01:11:57company overall. And I wanted
• 01:11:59to
• 01:12:00persuade you, no. Okay. This
• 01:12:02happens the same behavior happens
• 01:12:04again and again and again.
• 01:12:06I feel like I I
• 01:12:07only half answered your question,
• 01:12:09Joe. Okay.
• 01:12:13I I'm a psychiatrist and
• 01:12:15know something about the antipsychotics.
• 01:12:17So, for those of you
• 01:12:18who are asking about other
• 01:12:19companies, Public Citizen put out
• 01:12:21a report
• 01:12:22about ten years ago
• 01:12:24on the False Claims Act.
• 01:12:26Now it will come as
• 01:12:27a shock
• 01:12:28to this group to know
• 01:12:29that it's against the law
• 01:12:32to lie to the federal
• 01:12:33government.
• 01:12:34And that's a law that
• 01:12:36goes back to the civil
• 01:12:37war when people were
• 01:12:39selling false firearms
• 01:12:41to the union army.
• 01:12:43And,
• 01:12:44this report shows
• 01:12:46every one of these companies,
• 01:12:48was had paid liabilities of
• 01:12:51up to ten million dollars.
• 01:12:53And,
• 01:12:54so it it the knowledge
• 01:12:57was public. Now in terms
• 01:12:59of whether the research has
• 01:13:00been done,
• 01:13:01I've done enough research to
• 01:13:03sue,
• 01:13:05Jan Janssen, its subsidiary of
• 01:13:07Johnson Johnson in Texas. Lord
• 01:13:09knows.
• 01:13:10The attorney general of Texas
• 01:13:12sued Johnson and Johnson
• 01:13:14for prescribing
• 01:13:15to kids. And
• 01:13:17I don't know. Maybe it's
• 01:13:18bupkis, but they got a
• 01:13:19hundred and eighty million dollars,
• 01:13:21which I'm sure for Johnson
• 01:13:22and Johnson is just
• 01:13:25operating with the costs.
• 01:13:27But I should say that
• 01:13:28that back in the Clinton
• 01:13:30years, there were a number
• 01:13:31of major trials which revealed,
• 01:13:35in all many of the
• 01:13:35things you're saying about.
• 01:13:37And what happened was the
• 01:13:39study came out in the
• 01:13:39New England Journal,
• 01:13:41and there was a a
• 01:13:43lot of people, famous psychiatrists,
• 01:13:45planned this study.
• 01:13:47And,
• 01:13:48I think it was Pfizer
• 01:13:50that then held the conference
• 01:13:52for the sake of debunking
• 01:13:53the study and got many
• 01:13:56of the same people who
• 01:13:57designed it to stand up
• 01:13:58and say the study was
• 01:13:59flawed and was not worthwhile.
• 01:14:02Vacating trial. There's
• 01:14:04There's another dimension involving
• 01:14:06cost,
• 01:14:07which is just as poisonous
• 01:14:08and toxic that at their
• 01:14:11peak,
• 01:14:12these drugs were costing the
• 01:14:14country ten billion dollars.
• 01:14:16Whereas the older drugs, which
• 01:14:18this study showed to be
• 01:14:19just as good,
• 01:14:20would have cost one billion
• 01:14:21dollars.
• 01:14:22And that's more than all
• 01:14:24the salaries of all the
• 01:14:26psychiatrists
• 01:14:27in the America
• 01:14:29that was being paid for
• 01:14:30these heavily marketed drugs
• 01:14:32that the NIMH study showed,
• 01:14:35were no better than the
• 01:14:36older, cheaper drugs,
• 01:14:38but that the
• 01:14:39industry then had a major
• 01:14:42series of conferences
• 01:14:43debunking the findings. So I
• 01:14:45would I would and this
• 01:14:46was back in the Clinton
• 01:14:47era, so it doesn't apply
• 01:14:49now at all. Joe and
• 01:14:50I were working on this
• 01:14:51in the Clinton era. So
• 01:14:52yeah. But the research was
• 01:14:54The Katie trial. Yeah. Funding
• 01:14:56effectiveness research. Sure. I know.
• 01:14:59I know. But it was
• 01:15:00nixed. It's important. It was
• 01:15:02nixed by the industry,
• 01:15:04but, Public Citizen did get
• 01:15:06the data out there, although
• 01:15:07I don't know very many
• 01:15:08people paid attention to it.
• 01:15:09Yeah. Public Citizen, by the
• 01:15:11way, is
• 01:15:12the only organization really in
• 01:15:14the country that,
• 01:15:16has policed this industry consistently
• 01:15:19over the last forty or
• 01:15:20fifty years. And and Sid
• 01:15:22Wolf, who was their head
• 01:15:24of health for a long
• 01:15:25time and was a very
• 01:15:26close friend of mine recently
• 01:15:28died,
• 01:15:29and,
• 01:15:30was you know, it was
• 01:15:32founded originally by Ralph Nader,
• 01:15:34is one of the more
• 01:15:36remarkable organizations. I
• 01:15:38I do feel it's important
• 01:15:40to say
• 01:15:41there were five companies
• 01:15:42like Johnson and Johnson that
• 01:15:44manufactured
• 01:15:45atypical antipsychotics
• 01:15:46during this period. All five
• 01:15:48companies
• 01:15:49pleaded guilty to criminal charges
• 01:15:50of bribing psychiatrists.
• 01:15:53It just about I'm sorry.
• 01:15:55The vast majority of psychiatrists
• 01:15:57during this time
• 01:15:59were active participants, whether conscious
• 01:16:01or unconscious,
• 01:16:02in the deadliest criminal conspiracy
• 01:16:04in American history.
• 01:16:07And more than ninety percent
• 01:16:08took
• 01:16:09cash or
• 01:16:11or items of significant value
• 01:16:13from these companies.
• 01:16:15And this profession
• 01:16:17that,
• 01:16:18sees itself
• 01:16:20as,
• 01:16:23as, you know, suggesting we
• 01:16:25should all be aware of
• 01:16:26what we're engaged in,
• 01:16:28seem to not be aware
• 01:16:30of its engagement
• 01:16:32again in the deadliest crime
• 01:16:34in American history. It is
• 01:16:36not a compliment
• 01:16:37to this extraordinary profession of
• 01:16:40yours and others
• 01:16:41that psychiatry,
• 01:16:43was such an active participant
• 01:16:45in these crimes.
• 01:16:47Anybody else?
• 01:16:48I've heard two more questions,
• 01:16:50and
• 01:16:50two people have mics. So
• 01:16:52I have
• 01:16:53So I'm giving you a
• 01:16:54it's a very interesting talk.
• 01:16:56Although I would say that
• 01:16:57I think Europe has a
• 01:16:58drug problem. For any of
• 01:16:59us who've been in places
• 01:17:00like Zurich and watched all
• 01:17:02the drug addicts collect or
• 01:17:03been in Nepal and all
• 01:17:04the drugers came down from
• 01:17:06Europe and basically began a
• 01:17:08lot of the drug scene.
• 01:17:09But I think they treat
• 01:17:10it in a very different
• 01:17:12way in the health care
• 01:17:13system,
• 01:17:14which has been one of
• 01:17:15the reasons why it's not
• 01:17:16as bad. But I was
• 01:17:17gonna ask you about something
• 01:17:19else. There used to be,
• 01:17:20and I think there still
• 01:17:21is, but probably at the
• 01:17:22current political situation,
• 01:17:25it's not as active,
• 01:17:26but there was a very
• 01:17:27good place called the Institute
• 01:17:28of Medicine.
• 01:17:30And they used to put
• 01:17:31out bipartisan,
• 01:17:32extremely complete reports. I think
• 01:17:34they may have done one
• 01:17:35on talc
• 01:17:36in the early eighties.
• 01:17:39And they also have things
• 01:17:40on silicone implants,
• 01:17:42many, many things, and all
• 01:17:43of those reports are open
• 01:17:45to the public,
• 01:17:46and they're actually very complete.
• 01:17:48And I think what's happened
• 01:17:49with government is we have
• 01:17:51less of the investigative stuff
• 01:17:52going on,
• 01:17:54and the FDA is really
• 01:17:55basically,
• 01:17:57not just under the Trump
• 01:17:58administration,
• 01:17:59really basically become very corrupted
• 01:18:02by certain industries
• 01:18:03and players as in the
• 01:18:04Alzheimer drug, which is gonna
• 01:18:06eat up
• 01:18:07a whole health care system,
• 01:18:10amounts for something which is
• 01:18:11a very dangerous drug for
• 01:18:12some people.
• 01:18:14So I, you know, I
• 01:18:15think that you mentioned some
• 01:18:16things about doing more studies
• 01:18:17and
• 01:18:19advertising it. There used to
• 01:18:20be a guy here named
• 01:18:21Paul Levittis who used to
• 01:18:22talk about drugs and had
• 01:18:23a whole journal about it
• 01:18:25and was,
• 01:18:26was followed by the government
• 01:18:28the whole time for being
• 01:18:29un American. He was a
• 01:18:30great doctor.
• 01:18:31But I think also there
• 01:18:32are, there actually is part
• 01:18:34of the governments, they can,
• 01:18:35government institutes that are still
• 01:18:37there that I think can
• 01:18:38be encouraged to really
• 01:18:40go into some of these
• 01:18:41things with certain requests, and
• 01:18:43they do reports, which they
• 01:18:44can do reports, and they
• 01:18:46have the wherewithal on the
• 01:18:47scientists to really go into
• 01:18:49some of these studies that
• 01:18:50are very important in epidemiology.
• 01:18:53So the Institute of Medicine
• 01:18:54got rebranded as the National
• 01:18:56Academy of Medicine. So it's
• 01:18:57still around, still doing some
• 01:18:58reports, but as you point
• 01:19:00out medicine. Yeah.
• 01:19:02Not, often quite as aggressively.
• 01:19:07Hopefully, you can hear me.
• 01:19:08Thank you for your time.
• 01:19:09Appreciate it.
• 01:19:11You mentioned this is like
• 01:19:12a solutions oriented crowd. Yeah.
• 01:19:14But many of the solutions
• 01:19:15you
• 01:19:17posited,
• 01:19:18locate a lot of responsibility
• 01:19:20with the folks in this
• 01:19:21room, right, direct practitioners
• 01:19:23as well as regulatory agencies.
• 01:19:25Sure.
• 01:19:26But from my perspective, it
• 01:19:27seems like we're much farther
• 01:19:28down the causal chain
• 01:19:30than the bad business practices
• 01:19:32you were talking about, the
• 01:19:34ten dozen
• 01:19:35subsidiaries that Johnson and Johnson
• 01:19:36benefits from.
• 01:19:38So do you feel like
• 01:19:39the solution to these kinds
• 01:19:41of bad business practices
• 01:19:43is to just
• 01:19:44regulate away the profit incentive?
• 01:19:46Like, can we regulate away
• 01:19:47the profit incentive, or
• 01:19:50are we not leveraging
• 01:19:52tools like antitrust? Right? Like,
• 01:19:53J and J just won
• 01:19:54an antitrust lock like, lawsuit,
• 01:19:56I think, twenty four hours
• 01:19:57ago. You know? So are
• 01:19:59there is there no political
• 01:20:01will to, you know, dissolve
• 01:20:03these kinds of companies, you
• 01:20:04know, companies that were mentioned
• 01:20:05earlier, or is it really
• 01:20:06just on us to solve
• 01:20:08these problems? No. I I
• 01:20:10look. I think I I
• 01:20:12mean, I do offer a
• 01:20:13bunch of, you know, government
• 01:20:16solutions. I you know, the
• 01:20:17FDA
• 01:20:18makes two thirds of its
• 01:20:19budget from,
• 01:20:21fees from drug makers and
• 01:20:22device makers.
• 01:20:24Nearly all speeches from top
• 01:20:26FDA officials now
• 01:20:28to industry conferences,
• 01:20:29they talk about how the
• 01:20:31industry is their most important
• 01:20:32customer.
• 01:20:33It is clear that the
• 01:20:35the the agency has become
• 01:20:36wholly captive
• 01:20:38to the industry, I believe.
• 01:20:40And I I'm hopeful that,
• 01:20:44we can change that on
• 01:20:45a sort of a
• 01:20:47a political level.
• 01:20:49I do think that at
• 01:20:50this level, the micro level,
• 01:20:53you can do a lot.
• 01:20:54Like, one of my favorite
• 01:20:55studies about this, Jennifer knows,
• 01:20:57is this study it was
• 01:20:59this survey
• 01:21:00of residents at University of
• 01:21:02California, San Francisco. And
• 01:21:05they asked them,
• 01:21:07are you,
• 01:21:08affected by the free food
• 01:21:11and freebies and money
• 01:21:13that is given by farmer
• 01:21:15companies? And do you think
• 01:21:16your colleagues are affected? And
• 01:21:18something like twenty percent
• 01:21:20admitted that they were affected,
• 01:21:22but this eighty percent said
• 01:21:24that they thought their colleagues
• 01:21:25were affected.
• 01:21:26So it's one of the
• 01:21:27and it's the way conflicts
• 01:21:29of interest work in our
• 01:21:30heads.
• 01:21:31And that is that
• 01:21:33we all
• 01:21:34we all are conflicted
• 01:21:36on a variety of things,
• 01:21:37and we examine our conscious
• 01:21:39mind and, you know, is
• 01:21:40this money changing the way
• 01:21:42I'm thinking? And you don't
• 01:21:44see
• 01:21:44any sign in your conscious
• 01:21:46mind that it has,
• 01:21:47and so you absolve yourself.
• 01:21:49Well, no. I would have
• 01:21:50made this decision whether I
• 01:21:51got the money at all.
• 01:21:53When in fact, it's in
• 01:21:54your subconscious mind that pushes
• 01:21:57you toward making these decisions,
• 01:21:59because your wallet depends upon
• 01:22:01them. So I think we
• 01:22:03all just have to be
• 01:22:04aware
• 01:22:05that money matters, and money
• 01:22:07changes
• 01:22:08our minds.
• 01:22:10And we try to keep
• 01:22:11our decision making in medicine
• 01:22:14away from
• 01:22:16our sort of monetary
• 01:22:18incentives,
• 01:22:19and understand that you're as
• 01:22:21affected by this as everyone
• 01:22:22else. And try not to
• 01:22:24take, you know, these consulting
• 01:22:26gigs, which
• 01:22:28to this day, the industry
• 01:22:29reports spending three billion dollars
• 01:22:33buying America's physicians.
• 01:22:37I don't think this makes
• 01:22:38any sense, and I have
• 01:22:39these conversations with doctors
• 01:22:42all the time where they
• 01:22:43say, well, Gardner, I still
• 01:22:44do it. I mean, I
• 01:22:45don't think it affects me,
• 01:22:46but I can see how
• 01:22:48you're concerned. And it I
• 01:22:49just don't know.
• 01:22:51So I I do think
• 01:22:53you could do