TLDR Takeaways on Johnson & Johnson, Profits, Power, and Change
- Gardiner Harris’s “No More Tears” — which details Johnson & Johnson’s past and present — shows how a profit-first system encouraged corporations to profit by harming the most vulnerable, and how a compromised FDA let it happen.
- Fines, PR scandals, and boycotts don’t fix the core problem: power is too concentrated in a handful of companies, regulators, and political donors.
- We can put people before profits by spreading decision-making across many local, accountable centers (polycentric governance instead of a single captured gatekeeper).
- Sortition-based citizens’ assemblies and community oversight boards can bring ordinary people into health decisions — and tend to produce more trusted, less polarized recommendations.
- Local mutual aid networks, worker co-ops, and public or nonprofit manufacturers offer practical, proven ways to deliver care and medicines while incorporating a “people before profits” mindset at the design level.
- Your next move is not exclusively tied to a ballot box, protest, or lawsuit. You can join or build small, local mutual aid organizations and promote shared governance where you live.
No More Tears should put an end to excuses
I first purchased Gardiner Harris’s “No More Tears” (on audiobook) without much thought. It was the next book selected by my book club for reading and I was just rolling with it.
But as I listened to Harris detail Johnson & Johnson’s repeated history of exploitation toward some of humanity’s most vulnerable (babies, mothers, the elderly, the mentally ill, etc.), I was struck by just how much the pursuit of profit has warped the way we behave on both micro and macro scales.
Johnson & Johnson built its brand on babies and bandages. It promised that patients came first. Ethics courses even lauded the company for its handling of a Tylenol recall in the 1980s. But behind that image, there were decades of repeatedly similar bad decisions:
- Baby powder sold for years despite internal evidence of asbestos-related cancer risks
- Opioids and fentanyl patches marketed as safer and less addictive than they were
- Medical devices pushed through weak approval pathways that injured and maimed
- A COVID vaccine rollout tangled in manufacturing and safety failures
These aren’t one-off accidents. They sit on top of:
- An FDA that now relies on industry user fees for roughly three-quarters of its prescription drug review budget.
- A legal system where executives rarely face personal consequences, even when companies pay out billions in talc and opioid settlements while still pulling in close to $90 billion a year in revenue.
- A shrinking investigative press corps and growing “news deserts,” where 136 newspapers closed in the last year alone, leaving tens of millions of people with little local reporting at all.
But it does not need to be this way.
We can build systems that put people before profits by spreading power across many different points that directly involve regular people.
The problems No More Tears exposes
While No More Tears focuses mainly on one company, Johnson & Johnson, it highlights an entire system that is essentially rigged to benefit those at the top and exploit those at the bottom. The same people and companies control the money, the data, the regulators, and even the stories we hear.
Before we can talk about solutions, we have to see that we’re not just dealing with one reckless company — we’re living inside a growing monoculture of power that lets harm scale while shrugging it off as the cost of business.
Here are a few of the core problems No More Tears highlights.
The problem with systems of power
Throughout No Tears, Harris paints a picture of a regulatory agency that doesn’t have much power to begin, but gets increasingly compromised as time goes on. That agency is the Food and Drug Administration (FDA).
Today, the FDA gets about 45% of its total budget from industry user fees, and around 75% of the prescription drug review program’s costs come from these fees. While that doesn’t mean every person within the FDA is corrupt, it shows that this “watchdog” depends on the companies it is supposed to police.
At the same time, recent political shake-ups have fired key staff who negotiate those user-fee agreements, even though those fees fund most drug reviews. The firing of negotiation experts is liable to give industry giants an upper-hand in these negotiations. When one administration can gut the little remaining power of a regulator so easily, it highlights the dangers of centralization. It also highlights the way government and big business collaborate to increase profit at the expense of regular people.
Add in the collapse of local journalism, and you have a combo that is extremely dangerous. Newspaper newsroom employment has fallen by more than half since 2008, and over 3,000 newspapers have closed since 2005. Fewer reporters means fewer people with the time and backing to dig into complex corporate misconduct.
Additionally, since ads fuel newspaper profits, giant companies like Johnson & Johnson can throw their weight around and make bad stories disappear by threatening to cut advertising to news outlets that put them in a bad light.
In a system like this, it’s not surprising that J&J could allegedly sell talc products with asbestos contamination for decades despite internal memos, scientific reports, and now thousands of cancer lawsuits in the U.S. and U.K.
Clearly, there are problems throughout the systems of power our society runs on. It’s not like J&J is the only bad actor. There are problems in regulatory bodies, governments, businesses, and individuals.
The problem with a profit-driven world
Pretty much every bad decision that Johnson & Johnson makes in No Tears comes down to one thing: The pursuit of profit.
When your main duty is to maximize quarterly earnings, it distorts what is actually important, leading to things like:
- Downplaying serious side effects.
- Stretching a drug’s market far beyond its original approval or value.
- Treating safety concerns as a threat, instead of a call to slow down or stop.
J&J’s own numbers prove this. In 2024, the company reported about $88.8 billion in revenue and over $14 billion in profit.
Meanwhile, at the same time, they face:
- A proposed $6.5 billion settlement over talc-related ovarian cancer lawsuits.
- A $700 million settlement with states over deceptive talc marketing.
- Hundreds of millions in opioid settlements, while agreeing to exit the opioid business.
Those numbers sting, but they don’t fundamentally threaten a company making $14 billion a year.
And inside the system, profit warps incentives all the way down. A large systematic review of 36 studies found that when doctors receive payments from pharmaceutical companies, they prescribe more of those companies’ drugs, at higher cost, and prescribe more brand-name drugs overall.
When everyone is paid to sell more, and profit is the main motivator for our world, it’s not surprising that health concerns and risks to patients get brushed off.
The problem with profit as motivator
Markets are sold as a way to keep power honest. Compete or die. Innovate or lose. However, No Tears implicitly acknowledges truth in the old saying that money is the root of all evil.
If your duty is to maximize quarterly returns, every problem becomes a margin problem. Safety delays earnings. Transparency scares investors. Pulling a risky product means writing down assets. The system rewards people who ignore market signals, bury bad data, and hype benefits.
The same logic that is supposed to “discipline” companies instead drives them to:
- Push prices to the edge of what desperate patients will bear.
- Stretch clinical indications until half the country “qualifies.”
- Treat fines, recalls, and settlements as predictable costs, not red lines.
On paper, markets should spread risk and power. In practice, the profit motive pushes toward consolidation, risky deregulation, and information control — the exact failures markets were supposed to fix.
When everything is priced, anything that can’t be easily quantified — trust, safety, long-term health — starts to get sacrificed.
The problem with consolidation
No Tears also implicitly highlights problems with consolidation, monopolization, and centralization.
As noted above, we have:
- A handful of giant pharmaceutical and medical device companies.
- A small number of regulators with national reach.
- A shrinking field of major news outlets.
When a few firms dominate key markets, they gain leverage over regulators, suppliers, and even research agendas.
When just a few agencies control approvals, big business learns to target those choke points.
When a few media companies own most outlets, it becomes easier to control the narrative on any topic.
Consolidation makes harm scalable and accountability rare.
Why our current solutions keep failing
We’re told “no one is above the law,” but No Tears proves otherwise. When Johnson & Johnson cuts billion-dollar checks for settlements and fines, but keeps growing, fines stop looking like justice and start looking like just the cost of doing business.
Meanwhile, news organizations have difficulty speaking truth to power, and boycotts are largely ineffective against giants like Johnson & Johnson.
Fines and fees don’t promote corporate accountability
Lawsuits, settlements, and fines can feel satisfying. When a big settlement number hits the headlines, it can look like justice has been served.
But here’s the underlying truth:
- Companies delay, appeal, and negotiate.
- Payouts can stretch out over years.
- Insurance and tax deductions soften the blow.
- The people who caused harm keep their bonuses or quietly retire.
In J&J’s case, talc and opioid settlements add up to billions. Yet total annual revenue keeps rising. When companies make so much money and fines don’t scale with it, they simply become a line item instead of a punishment.
Real accountability would:
- Target executives personally when they sign off on deceptive or deadly strategies.
- Tie future licensing and government contracts to a company’s safety and honesty record.
- Give harmed communities formal power over remediation, not just a place in line for compensation.
Right now, we mostly do none of that.
Deregulation compromises centralized watchdogs
The FDA is full of people who care about public health. It is also trapped inside a funding structure that compromises its independence.
User fees — payments from drug and device makers to speed review — now cover about 45% of FDA’s overall budget and about 75% of the prescription drug review program.
Those fees are renegotiated every five years in intense talks between the FDA and industry. They come with performance targets: faster reviews, more meetings, more guidance. When Congress underfunds the agency, it leans even harder on fees from the companies it regulates.
Recent political moves have made this even more fragile. Layoffs of key negotiators have been framed as efficient budget cuts. Meanwhile, there is continued pressure to loosen certain rules, like asbestos testing in cosmetics, even though there is decades of evidence that asbestos kills tens of thousands each year.
In No More Tears, you can see how J&J exploited this structure — from shaping talc testing standards to moving complex medical devices through weaker pathways like 510(k), which allows new devices to piggyback on old ones.
A centralized regulator that depends on industry money is a highly-compromised single point of failure.
Investigative journalism is on life support
Investigative journalism is one of the only tools ordinary people have to see inside opaque systems.
But the economics of news have cratered:
- U.S. newspaper newsroom employment fell 57% between 2008 and 2020.
- Since 2005, the U.S. has lost nearly 3,000 newspapers, creating vast “news deserts” with little or no local coverage.
That means fewer reporters covering statehouses, hospital boards, and court documents.
J&J’s story came to light thanks to years of work by journalists and lawyers poring over memos, trial records, and FDA filings. But in many communities, there is no one left on salary to do that work.
And J&J definitely did its best to make sure many stories never saw the light of day. As a company with a gigantic advertising arm, it managed to suppress stories at news organizations by threatening to pull advertising.
We count on journalism to compensate for weak regulators and concentrated power. Yet, in a profit-driven world, we have not built a durable model for it to thrive.
Boycotts and public outrage don’t work effectively against corporate giants
Boycotts can do a few useful things. They raise awareness. They shift cultural norms. They can nudge brands that are already sensitive to reputation to act.
But boycotts run into hard limits, especially when it comes to big pharma:
- Many patients have no alternative to a given drug or device.
- Long, complex supply chains make it hard to know who made what.
- Hospital purchasing happens through group contracts, not individual consumer choice.
In such a climate, boycotts act more like a pressure valve. We vent every few months and then return to life as usual.
What we need instead are new, people-centered systems and solutions.
People-centered alternative solutions
It can be argued that one of the points of No More Tears isn’t just that J&J has acted unethically and dangerously, killing thousands each year — but that this is the system working as intended.
If we want to change the way corporate giants, politicians, and the ultra-wealthy exploit everyday regular people, we need to fundamentally change this system to one that is people-centered instead of profit-driven.
Polycentric governance: many centers, shared guardrails
Polycentric governance sounds academic, but the idea is simple: instead of one big center making all the calls, you have many connected centers that share responsibility and watch each other.
In public health, that can mean:
- Multiple overlapping health authorities — local, regional, national — with clear roles and ways to challenge each other.
- Shared data commons where hospital outcomes, adverse events, and trial results are open by default.
- Independent labs and university centers with stable public funding to verify what companies claim.
Research on polycentric systems shows they can be more resilient because failure in one node doesn’t crash the whole system. They also create more entry points for citizen participation.
In practice, that might look like:
- A city-level drug safety council with power to issue warnings and negotiate purchasing contracts.
- A state-level office that audits physician payment data and hospital quality metrics.
- A national FDA that still approves drugs, but shares surveillance and enforcement power with these smaller centers instead of hoarding it.
This way, no single bad actor can bury bad news.
Sortition and citizens’ assemblies: ordinary people in the room
Sortition means selecting decision-makers by lottery, like jury duty, instead of by party, money, or popularity.
Citizens’ assemblies take a random, representative group of people, give them time and support to learn about an issue, and ask them to make recommendations.
We’ve already seen this work:
- France’s Citizens’ Convention for Climate brought 150 randomly chosen people together to craft policies for cutting emissions. Their proposals were more ambitious and often more trusted than party-line plans.
- A growing network of climate assemblies across Europe has developed practical guidance for how to run these processes — how to recruit, how to balance experts, how to turn recommendations into action.
Health policy could use the same tool:
- A citizens’ assembly on prescription drug safety in your state, reviewing evidence on opioids, antidepressants, or weight-loss drugs, and issuing binding recommendations.
- A local assembly on hospital consolidation, deciding when mergers actually serve community health and when they just strengthen monopolies.
- A citizens’ panel on informed consent that designs the actual forms and videos patients see, instead of leaving that work to lawyers and marketing teams.
Assemblies put expert knowledge in a room with people who actually have to live with the consequences of policy decisions — and allows them to build policies that serve them.
Local mutual aid networks: infrastructure, not charity
During COVID, mutual aid groups helped deliver food, medicine, and information faster than many formal programs. They reached people who lacked internet access, spoke different languages, or distrusted official channels.
Studies of these groups show something important:
- People who participate often report increased well-being, a stronger sense of belonging, and a belief that they can shape their community.
In other words, mutual aid doesn’t just move resources. It builds the social fabric any serious accountability system needs.
Treating mutual aid as infrastructure means:
- Municipal funding and space for local care networks.
- Coordination with public health departments during crises.
- Clear pathways for mutual aid groups to influence policy, not just “fill gaps.”
Think of it as a neighborhood-level early warning system and care net.
Business co-ops and people-first firms
If we want people-before-profits healthcare, we also need people-before-profits businesses. Worker cooperatives and public-benefit companies are proof that companies can be driven by goals other than profit.
Take Mondragón in Spain, one of the world’s largest worker-owned cooperative networks. It includes more than 100 co-ops and tens of thousands of worker-owners. Its stated goal is to produce “rich societies,” not rich individuals — and treats jobs and community stability as core metrics.
Closer to health, Civica Rx is a nonprofit generic drug company formed by U.S. hospital systems to produce essential medicines at stable, affordable prices. Today it supplies more than 70 medications to over 1,400 hospitals and is building U.S. manufacturing for generic injectables and insulin.
These models matter because they:
- Give workers and communities formal power over major decisions.
- Align incentives around reliability and affordability, not profit margin.
- Make it easier to commit to, and enforce, putting people before profits.
If more of our essential drugs and medical tools came from companies truly focused on the well-being of their customers and communities, it would radically elevate the quality of life for people everywhere.
What this could look like in an ordinary week
This can all feel abstract. So let’s drop into a week in a town that leans into these tools.
- Monday: You open your local paper — funded by a public-philanthropic trust, not just ads — and see a story on a citizens’ assembly that just released recommendations on opioid prescribing and tapering. Your city council has to formally respond within three months.
- Tuesday: A neighbor texts the mutual aid group chat. Someone’s mom just left the hospital early because they couldn’t afford another night. Within hours, people organize rides, meals, and help tracking down financial assistance. The group also logs the case in a shared dashboard that feeds anonymized data to a regional health equity council.
- Wednesday: You attend a public meeting of the community health oversight board. Half the seats are elected, half drawn by lottery. They’re questioning your local hospital about its partnership with a device maker whose implants have racked up serious safety complaints elsewhere.
- Thursday: Your primary-care clinic, owned as a worker co-op, holds a quarterly member meeting. Staff share financials. Patients vote on whether to join a nonprofit drug purchasing pool that works with manufacturers to lock in fair prices for generics and insulin.
- Friday: You get an email from your city: a short, plain-language video explaining new informed-consent tools for risky procedures. Notably, the video script was developed by a citizen panel of residents, patients, and clinicians — not a marketing department.
- Weekend: Your book club meets to discuss a book like No More Tears. Instead of ending on despair, you use a simple agenda that helps you map local power, list existing mutual aid and co-op efforts, and commit to one next step.
None of this is easy, but it also doesn’t require constitutional reform or an act of Congress. it is all within the realm of possibility.
How to start (or join) experiments where you live
We can’t realistically build a full alternative system today, or even this year. But we should start laying the groundwork.
Here’s a simple, outcome-first playbook:
- Map what already exists.
- Search for “[your town] mutual aid,” “[your town] tenants union,” “[your town] health equity coalition.”
- Ask a local librarian what community groups work on housing, food, or health access.
- Pick one structure to explore.
- A mutual aid group that helps with rides, groceries, or meds.
- A local co-op (food, childcare, clinic) or credit union.
- A neighborhood association that actually takes action and sees results.
- Show up once, then again.
- Attend one meeting or call.
- Volunteer for one concrete task with a clear end point.
- After you finish, decide whether to take on the next step.
- Plant one governance seed.
- Suggest a small lottery element: for example, resolving a tricky local issue with a citizens’ assembly.
- Offer to help design simple, clear consent or information materials, with real people, not just professionals, in the room.
- Tell other people what you’re doing.
- Share one story where the group helped someone — respecting privacy.
- Use language like we’re trying to build people-before-profits healthcare in our town.
Remember: the goal is not perfection. The goal is more centers of power, rooted in care, that can see and respond to harm faster than distant boardrooms or congressional halls.
From outrage to ownership
It’s tempting to throw all our outrage at these companies and the rich — attempt to break them up or put them behind bars.
And those fights matter. But if No More Tears teaches anything, it’s that we cannot rely on companies, regulators, and politicians to act in our interest in a profit-driven world.
So, instead, we need to focus on disempowering these entities and replacing profit as the driver of our systems. We have the tools to do this: Polycentric governance. Citizens’ assemblies. Mutual aid. Co-ops and nonprofit manufacturers. Community oversight.
These are already working, in pieces, around the world.
So tying everything together here:
Identify one mutual aid, accountability, or community-governance effort near you — or start a tiny one with two friends — and commit to showing up once in the next month.
FAQ: Big pharma, profit motive, and systems of power
Does this mean we should get rid of the FDA?
No. We need stronger, more independent regulators, not none at all.
The problem is not that the FDA exists. The problem is that user fees and political interference distort its incentives.
Polycentric governance adds more centers of review and oversight — local, regional, professional, and citizen-led — so the FDA is one node in a bigger network, not the only gatekeeper.
Isn’t sortition too radical or slow for health decisions?
Sortition already shapes life-and-death decisions in jury trials. We trust ordinary people with that power when we give them time, information, and support.
Citizens’ assemblies use the same approach for policy. Experiences in France, Ireland, and dozens of local climate assemblies show that these bodies can produce clear, practical recommendations within months, not years.
For health, assemblies could focus on priority topics — opioids, informed consent, or hospital mergers — rather than every decision.
Additionally, you can run an unlimited amount of citizens’ assemblies at one time on any number of topics. This makes it easier to tackle many problems in the same time it takes a body like Congress to tackle one.
Won’t mutual aid burn people out?
Research from COVID-era mutual aid groups found that many participants reported improved well-being, stronger community ties, and a sense of agency — when groups kept scopes realistic and shared work.
Treat mutual aid as part of the public health ecosystem, with modest funding and clear boundaries.
Are worker co-ops and nonprofit drug makers actually competitive?
Yes. Mondragón’s worker-owned network has survived and grown over six decades, through multiple crises, while prioritizing jobs and community stability.
Civica Rx now supplies more than 70 medications to over 1,400 U.S. hospitals and is building U.S. manufacturing for generic injectables and affordable insulin.
These models prove that you can compete while putting people before profits.
What if I don’t have time to join a group?
You probably don’t have time to fix the whole system. You might have time for:
- One meeting in the next month.
- One carpool, food drop, or translation help for a neighbor.
- One email asking your city council to support a citizens’ assembly.
Start with the smallest action and work from there.