‘The Johnson & Johnson Files’ review: The Indian Express journalist Kaunain Sheriff M exposes the global giant’s dark legacy in India

This book, written following the global recall of the Articular Surface Replacement (ASR) hip implants by the Johnson & Johnson (J & J) company, is an eye opener in many ways. On one hand, it dissects the impropriety and the dishonesty of J&J in hiding away the complications, particularly from its patients (read Indian patients) and on the other hand, it exposes the company’s blatant audacity in the misuse of power, money and reach in trying to not only avoid the lid from blowing off their defective implant but also from hoodwinking in providing compensation to a cohort of patients, namely those from less privileged, ‘patient unfriendly’ countries like India.

The book has a significant human element to it, making it easily readable. From amongst the six parts of the book, the first part tells us the stories of Dinesh from Pune, and Monica from Southern Orange County, California. Both landed up at the operating tables of (Indian) orthopaedic surgeons who were cocksure of the procedure and, more importantly, the ASR implant that was yet to establish itself in the world. Unfortunately, both the patients end up in misery with pain, impoverishment and disability.

Kaunain, National Health Editor, The Indian Express, correctly writes that to boost the billion-dollar hip implant business, a correct mix of patients, surgeons and technology is essential. It’s a strategy that focuses on monetary success. This is something akin to an ice-cream vendor choosing to park his cart in a spot near a school gate to maximise his sales. Like the ice-cream vendor, implant companies, like Johnson & Johnson, also choose surgeons to lure them into doing their implants. The story of one such surgeon — Dr Antonio Nargol, an Indian-British surgeon working in the National Health Service in the UK — finds mention in the book. In view of his high-volume practice, Nargol was targeted by J&J in 2004, coaxing him to change his practice from doing one kind of hip replacement to doing their ASR hip implants. Interestingly, when Nargol noticed the first few of his ASRs failing, he doubted himself more than the implant. Such is the convincing power of implant companies like J&J.

Kaunain’s book is not to be read for its prose but for its prowess to investigate an ‘international crime’ against the human race; a crime where the collective responsibility of all those surgeons, who operated using this defective implant, is no less than that of the company that provided these implants. To believe that the surgeons putting these hip implants into human bodies were innocent, despite their more intelligent and more honest colleagues red flagging these, would be to let them go scot-free in a world where conjecture and assumption forms the basis of market forces establishing themselves. It is like believing everything we see and hear on social media in today’s world of fake news.

In the Indian context, the real problem of the defective ASR implant was the lack of data on Indian patients which, unfortunately, forms a common pivot regarding all healthcare parameters in this country. In 2012, there were a total of 10,750 lawsuits against the ASR in the United States. There was a $250 million dollar settlement with a class-action lawsuit in Australia. By early 2017, the tide of lawsuits began to settle across the world. But there was nothing in India. The company was deafeningly silent on its Indian patients who had undergone similar pain and misery following surgery with ASR implants. Interestingly, most patients who had the ASR implant weren’t unaware of the global recall of the implant but they didn’t get any call from their surgeons or from J&J. They had ceased to exist for both.

Kaunain’s book also traces the functioning of the Indian regulators and the Indian government with regard to this global swindle. Privileged corporates like the J&J have a pervasive impunity within the Indian health system. It took nearly a decade for the Indian regulators to wake up to the reality of fraud played up by J&J. The first meeting of a committee formed by the government to look into the issue of impropriety of the ASR implant was held on March 8, 2017. The discussion in this meeting revolved around compensation but the representatives of the company at the meeting revealed that nearly seven years after the recall, only 1,028 ASR patients had registered through the company’s helpline, with only 253 of them undergoing revision surgeries. Thus, more than 70 per cent of Indian patients with ASR remained untraced.

For someone with an orthopaedic practice spanning more than 20 years, I can say that this is quite impossible as all implants put in human bodies are accounted for not only by the operating surgeon but also by the vendor who provides the implants as well as the company supplying them; J&J in this case. It is horrifying, frustrating and a bit preposterous to digest that lack of patient data can happen despite these three levels of accountability. Kaunain rightly calls ASR, the “deepest wound of the company”. The book ends with the tragic Daisy Barucha court case against the J&J company, a case which shows the devastating effects of the ASR metal on metal implants.

In my opinion we and, most importantly, the doctor should read The Johnson & Johnson Files, because the unethical behaviour of J&J is neither the first nor the last episode in the ongoing tragedy that is the saga of the poor Indian patient. With poor regulatory mechanisms, a corrupt healthcare system and a greedy doctor at their doorstep, such companies and their businesses stand to thrive in the graveyard of India’s healthcare. And this is what this book cautions us against.

The writer is professor of Orthopedics, AIIMS, New Delhi. Views are personal