The Johnson & Johnson Files: Unhealthy truths and defective hip implants

A tale of defective hip implants exposes India's weak medical oversight - and how multinationals treat Indian patients worse than those in rich countries

The Johnson & Johnson Files:  The Indian Secrets of a Global Giant

by Kaunain Sheriff M.

Published by Juggernaut

379 pages ₹599

 

In 1998, Johnson & Johnson (J&J) — known for everything from band aids to baby powder — took over DePuy for a whopping $3.5 billion dollars. DePuy Inc, a Warsaw-based company, was one of the largest and most respectable names in hip and knee implants in the world. It was the second-largest player in these areas in the US market and had a presence in 23 countries, including India. It was a great buy — within just over a decade, it became the brightest star in J&J’s fold and hit $5.4 billion in annual sales in 2010. A revolutionary hip implant, DePuy had introduced and aggressively marketed had become a roaring success and DePuy was the jewel in J&J’s crown. The success story would start unravelling soon, though.

 

Kaunain Sheriff, national health editor at The Indian Express, tracks the story of this unravelling — and more importantly about how the global giant kept selling the defective hip implants in India long after it had realised the implants were causing major problems in other markets around the world. And the book also examines how it fought to ensure that it had to give the least amount of compensation to Indian patients, compared to those in other countries.  In the process, Mr Sheriff examines not only the behaviour of J&J (or DePuy) senior management but also the problems in India’s healthcare system, and why the Indian medical regulatory framework requires a major overhaul to ensure that Indian patients are treated by multinational giants in the same way as patients in developed countries.

 

Mr Sheriff is an adept storyteller. The book moves from case studies to the global background and marketplace, and then back to India. It examines in detail the launch of a product with much promise by DePuy to wrestle the numero uno position in the hip replacement market from the market leader, the aggression of its marketing staff and the dramatis personae — from the leader of hip replacements in the UK to the Indian patients to a honest Indian bureaucrat who played a crucial role in putting evidence together that J&J was selling a product that was creating major problems for patients.

 

Most importantly, Mr Sheriff also looks at the problem of implants and other devices that are often cleared for patients by regulators in Western countries on the basis of a certain amount of data presented to them — and marketed aggressively by the company only for serious problems with the product becoming clear much later after thousands of patients have already started using them. Mr Sheriff also shines the spotlight on regulators who should have the patient’s best interests in mind but are sometimes swayed by their close association with the company selling the flawed products.

 

While this book is about DePuy’s then new hip replacement product, it also applies to many other cases. Multinationals with multi-billion dollar budgets often influence regulators, doctors and surgeons in many countries. For patients who are affected by a faulty product and whose lives will never be the same, it is an unequal battle given their limited resources. More importantly, the compensation they win — if they manage to win — is often far less than what they should ideally get.

 

Mr Sheriff’s book is a fast read, though it is occasionally repetitive. The book switches from the big global picture to a few patients who were unlucky to have been recommended (and agreed to) a defective product. Their stories are heartbreaking. And they are not just Indian citizens — one example is a woman who flew from the US to India because of the lower costs here and the country’s growing reputation as a medical tourism destination. She had done her research, and nothing she found at the time indicated that J&J’s product could be the culprit. However, she began suffering from pain shortly after the surgery and grew progressively worse during her flight back home.

 

But there are also a few heroes. From a distinguished orthopaedic consultant called Antoni Nargol in the UK to Mahesh Zagade, an IAS officer, whose diligent investigation helped build the Indian case. Dr Nargol, who can trace part of his ancestry to India, was aggressively wooed by DePuy to try out its devices — and also one of the first to realise it was creating problems for his patients. He would be a key person whose work ensured the recall of the device. Mr Zagade, an honest bureaucrat, would put together key evidence of the problems before he was transferred. The book is a good but also scary read about the world’s deep-pocketed healthcare multinationals and the broken regulatory system, especially in India.

           

The reviewer is former editor of Business Today and Businessworld, and founder of Prosaic View, an editorial consultancy