TIME Crime

How Poisoned Tylenol Became a Crisis-Management Teaching Model

Tylenol 1982
Bottles and boxes of Tylenol products which were taken off the shelves or returned to a Safeway store, on Oct. 1, 1982 Jim Preston— The Denver Post / Getty Images

Sept. 29, 1982: The first three of seven victims are killed by poisoned Tylenol in the Chicago area

The killer’s motives remain unknown, but his — or her, or their — technical savvy is as chilling today as it was 30 years ago.

On Sept. 29, 1982, three people died in the Chicago area after taking cyanide-laced Tylenol at the outset of a poisoning spree that would claim seven lives by Oct. 1. The case has never been solved, and so the lingering question — why? — still haunts investigators.

According to TIME’s 1982 report, Food and Drug Administration officials hypothesized that the killer bought Extra-Strength Tylenol capsules over the counter, injected cyanide into the red half of the capsules, resealed the bottles, and sneaked them back onto the shelves of drug and grocery stores. The Illinois attorney general, on the other hand, suspected a disgruntled employee on Tylenol’s factory line. In either case, it was a sophisticated and ambitious undertaking with the seemingly pathological goal of killing strangers entirely at random. Their symptoms and sudden deaths confounded doctors until the link was discovered, traced back to identical pill bottles that each smelled like almonds — the telltale scent of cyanide. The perpetrator left no margin for error, filling the capsules with poison at thousands of times the amount needed to be fatal.

One victim, 27-year-old Adam Janus, took Tylenol for minor chest pain and died within hours. His younger brother and sister-in-law were killed after taking pills from the same bottle while grieving the sudden, shocking loss at Janus’ house.

TIME’s Susan Tifft wrote of the tragedy’s victims on Oct. 11, 1982:

Twelve-year-old Mary Kellerman of Elk Grove Village took Extra-Strength Tylenol to ward off a cold that had been dogging her. Mary Reiner, 27… had recently given birth to her fourth child. Paula Prince, 35, a United Airlines stewardess, was found dead in her Chicago apartment, an open bottle of Extra-Strength Tylenol near by in the bathroom. Says Dr. Kim [the chief of critical care at Northwest Community Hospital]: “The victims never had a chance. Death was certain within minutes.”

Without a suspect to revile, public outrage could have fallen squarely on Tylenol — the nation’s leading painkiller, with a market share greater than the next four top painkillers combined — and its parent corporation, Johnson & Johnson. Instead, by quickly recalling all of its products from store shelves, a move that cost Johnson & Johnson millions of dollars, the company emerged as another victim of the crime and one that put customer safety above profit. It even issued national warnings urging the public not to take Tylenol and established a hotline for worried customers to call.

Tylenol relatively quickly reestablished its brand, recovering the entire market share it lost during the cyanide scare. Though things could have gone very differently, the episode’s most lasting legacy has been in the annals of public relations, not poison control: the case has since become a model for effective corporate crisis management.

Read the 1982 report on the poisonings, here in TIME’s archives: Poison Madness in the Midwest

TIME medicine

Male ‘Enhancement’ Drugs Called Dangerous Amid FDA Crackdown

Turns out, bigger can be badder: Many products claiming to enlarge men’s genitals are deceptive and potentially even deadly, according to federal experts

Turns out, bigger can be badder: Many products claiming to enlarge men’s genitals are deceptive and potentially even deadly, according to federal experts and doctors.

The U.S. Food and Drug Administration, seeking to curb what it calls “an emerging trend,” has issued 20 public notifications this year concerning 20 “tainted” Internet products with names like Weekend Warrior and O.M.G. that promise male “sexual enhancement.”

Yet months after the FDA warnings, some of these supplements are being sold on mainstream retail websites…

Read the rest of the story from our partners at NBC News

TIME medicine

Look Up Your Meds On This Massive New Drug Database

Iodine

The Yelp of medicine is here

Iodine, a new health start-up from a former Wired editor and Google engineer offers an easy-to-use database of drug information.

The database, which launched on Wednesday, uses Google surveys to get consumer information on a wide variety of both over-the-counter and prescription drugs. Users can search a specific drug from Aleve to Xanax and see how people generally feel about its efficacy, about the side effects from actual users, tradeoffs, comments from users, warnings, costs, and a readable versions of the drug’s package insert.

And the database will continue to grow. According to the New York Times, Iodine uses Google Consumer Surveys, of which they have 100,000 ones completed, and they add to their website every day. Iodine also uses data from clinical research, pharmacist surveys, adverse event reports made to the Food and Drug Administration (FDA) and the National Average Drug Acquisition Cost (NADAC)–which reports the average wholesale price pharmacies pay for over 20,000 drugs.

Thomas Goetz, the former Wired editor and co-founder of Iodine told the Times that Iodine is developing the largest survey of American’s drug use and experiences which could not just help consumers but help impact policy.

The folks behind Iodine may have actually succeeded in making Big Data useable—and helpful.

TIME Innovation

Five Best Ideas of the Day: September 24

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Because of America’s unique relationship with Liberia, we have an obligation to help fight the Ebola outbreak there.

By James Ciment in Slate

2. Medical research often doesn’t account for different ethnicities, and underrepresented groups suffer.

By Estaban G. Burchard in Nature

3. One way to head off sexual violence in professional sports: start with high school coaches.

By Libby Nelson in Vox

4. Beyond the sharing economy: Is “reputation” the next important currency?

By Heather Schlegel on CNN

5. Powerful protests over climate change target corporations – and new leadership is needed to restore faith in capitalism.

By Judith Samuelson in the Huffington Post

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

When Doctors Ignore Their Own Advice

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What to do about docs who smoke, drink, and tan

I live near a health clinic, and on more than one occasion, have walked by men and women in scrubs smoking cigarettes. No human being is immune to nicotine’s addictiveness, but since health care professionals are supposed to advise patients against such behaviors, it’s extremely hard to justify the habit.

Earlier this month, a report published in The BMJ showed that one in 10 doctors admit to using tanning beds. The survey sample was small at only 163 U.K. doctors, but considering skin cancer is the most common cancer in the U.S., the fact that any physician would choose to partake in an activity that puts them at a direct risk for cancer is pretty mindboggling.

But indoor tanning isn’t the only doctor vice. Smoking, poor eating habits, being sedentary, and heavy drinking–while still not the norm–are behaviors not completely eradicated from the medical community.

An unforgiving culture

“It’s unrealistic to expect that knowledge should prompt physicians to avoid unhealthy behaviors,” says Anthony Montgomery, an associate professor of work and organizational psychology at the University of Macedonia in Greece. “Just like everybody else, they have a low risk perception with regard to their health.”

Montgomery says a big part of the problem is how physicians cope when they encounter health problems. In a 2011 study, Montgomery and his colleagues conducted an analysis published in Occupational Medicine that looked at 27 studies on doctors self-medicating. They wanted to examine the implications of a persisting culture within medicine where doctors do not expect themselves or their colleagues to be sick.

“We found that there was considerable evidence that physicians and medical students engage in high levels of inappropriate self treatment for reasons that include avoiding the patient role and occupational norms–keeping things inside the profession,” he says.

The study concluded that these behaviors could be occupational hazards for doctors, and that these problems are not benign for patients. Congruent research finds that doctors with bad health habits are less likely to counsel their patients on the same issues.

“Fifty years ago smoking was very common among physicians and nurses, though fortunately we’ve reduced that significantly,” says Shiv Gaglani, co-founder of a pledge for medical students called The Patient Promise. “Now however, physicians and nurses have the same level of obesity as the general population. Our caregivers are human too and can succumb to same behaviors that everyone else can.”

Montgomery, who typically studies doctor burnout, is working on a report that collected data from health care professionals in Croatia, Portugal, Macedonia, Greece, Turkey, Romania and Bulgaria and found that the effects of burnout were significant predictors of fast food consumption, infrequent exercise, drinking alcohol and using painkillers.

“Certainly most physicians I’ve met understand the paradox between what they preach and what they practice,” says Gaglani. “Seeking help is often complicated by the fact that you don’t want word to spread about your issues because it would spread within the community you practice. In some cases it could even mean the end of your career.”

Solutions

Gaglani created The Patient Promise in 2008 with his roommate at Johns Hopkins Medical School after they attended a course on obesity and motivational interviewing of patients.

“We realized that many of the harmful lifestyle behaviors we were learning to counsel against as future physicians were actually becoming part of our daily lives,” says Gaglani.

The pressure and stress of medical school was causing Gaglani and his peers to eat less nutritious food, exercise fewer times each week, and get significantly less sleep. “We asked the simple question: How can we counsel patients on important lifestyle behaviors if we couldn’t practice them ourselves?” says Gaglani.

And so the Patient Promise was created, and still serves as a pledge for health care workers to live the lifestyles they are recommending for their patients. The movement calling for doctors to be healthy has spread to many health care facilities.

Some hospitals have even incentivized healthy behaviors, like the Cleveland Clinic, which took staff health to task in 2014 and asked all of its employees to wear an activity tracker called Pebble. Target goals were set across the board, and participating in the program allows employees to get lower health insurance premium rates. So far out of the 26,790 employees and spouses participating, 18,302 have already met their target goal for the year: 100,000 steps a month or 600 activity minutes a month for six months.

The Patient Promise is available for all health care workers to sign as a pledge to patients and themselves. “We believe in the power of partnership and shared accountability between clinicians and their patients to lead healthier lives,” says Gaglani.

TIME medicine

Generic Drug Discount Programs Work — for Everyone

Americans are increasingly participating in programs that fill cheaper versions of prescription drugs

More and more Americans are buying the cheaper generic versions of prescription drugs, new research published in JAMA Internal Medicine shows.

In 2006, Walmart introduced what would become one of many generic drug discount programs that allowed people to pay just $4 to fill prescriptions of generic drugs. The program was meant to help people meet difficult medical costs–especially more vulnerable groups like the elderly and low-income populations.

At first, the program didn’t appear to gain a lot of traction. In 2007, only 3.6% of patients receiving prescription drugs were partaking in a program. But similar programs popped up at other pharmaceutical retailers like Rite Aid, CVS and Walgreens and has since gotten much more popular.

The researchers looked at a 2010 national household survey of health care usage among patients over age 18 who had at least one prescription during that year. They found that among the 13,486 adults identified in the survey as having at least one drug prescription, 3,208 were users of generic drug discount programs, and overall program use was at about 23%–much higher than the 3.6% participation rate three years earlier.

Researchers also found that people who were elderly, sick, uninsured and living in rural areas were more likely to participate in the programs, but interestingly, there were no significant differences across education levels or race/ethnicity groups. “Generic drug discount programs were not considered inferior despite the common perception that generic drugs are of poor quality,” the study authors write. “In fact, generic drug discount programs offer convenience by not requiring insurance claims to be filed.”

The researchers think the mere fact that more pharmaceutical retailers have offered similar programs is one of the reasons there’s greater uptake across the board, and while participation could still be higher, plenty of people of different backgrounds are taking part in the cost savings programs.

TIME medicine

5 Signs Your Hormones Are Out of Whack

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Getty Images

When it's normal, and when to see your doctor

Raise your hand if, in the last few weeks, you’ve felt tired, bloated, or cranky. Sound familiar? Then you know the drill: Every month, your hormones—the body’s itty-bitty secret weapon—come out to play, wreaking havoc on your mood, skin, and mind. While levels generally stabilize after your period, various factors, like stress (yup, keep those hands raised) and anxiety can throw them off balance. So how can you tell if your symptoms require an office visit? Alyssa Dweck, MD, an OB-GYN at the Mount Kisco Medical Group in New York shares the five red flags that might merit a doctor’s note.

Fatigue

Exhaustion is one of the most, well, exhausting symptoms to a doc, since it has so many possible causes. “If you’re tired after a week of final exams or late nights at work, then you’re probably fine,” says Dr. Dweck. “But if you constantly feel worn out and notice weight gain, appetite fluctuations, and a change in bowel movements, it could be a sign of an underactive thyroid.” Yes, fatigue happens to everyone, but if yours doesn’t feel logical, then it’s worth getting it checked out.

Skin changes

You’re breaking out—again. While those sudden zits could be caused by one too many nights of going to bed without washing your face, they may be indicative of something more. “Adult acne or cystic acne around the lower half of your face could suggest a high level of testosterone,” says Dr. Dweck. Although not a life-threatening problem, breakouts can take a toll on your psyche. Luckily, your doc can prescribe you medication to stabilize your hormone levels and clear up skin.

Hair growth

We’re talking really fast hair growth. “If you all of a sudden grow a beard within a month or notice coarse, dark hair popping up on your chest, back or arms, that could be indicative of a testosterone-secreting tumor,” explains Dr. Dweck. But don’t freak out: Tumors are rare, she notes, and can often be treated with drugs or surgery.

Weird periods

Just like fatigue, a messed-up menstrual cycle can be the result of many factors, like stress, thyroid issues, low estrogen, or polycystic ovary syndrome (PCOS). “The hallmark of PCOS is irregular or absent periods, but it could also present with difficulty losing weight or strange hair growth,” says Dr. Dweck. Generally, PCOS is managed through diet, exercise and birth control pills, but your doctor will work with you to develop a multi-faceted plan if she finds this to be the cause of your period problems.

Night sweats

Unless it’s unusually warm in your bedroom, waking up feeling overheated and sweaty could be the result of lower estrogen levels and infrequent ovulation—aka perimenopause. “Perimenopause can occur up to 10 years before you’re even near the age of menopause,” says Dr. Dweck, “so unless you’re having major menstrual issues before age 40, there’s a good chance your phantom sweating could actually be early menopause.” Either way, Dr. Dweck recommends making an appointment with your doc to make sure it’s nothing more serious.

This article originally appeared on Health.com.

TIME Innovation

Five Best Ideas of the Day: September 22

1. A global transformation from a carbon-based economy to a cleaner, more sustainable energy future will create jobs and add wealth.

By Christiana Figueres and Guy Ryder in Project Syndicate

2. Antibiotic resistance causes 23,000 deaths and two million illnesses every year. Concerted government action is necessary to fight the crisis.

By the Editorial Board of the Washington Post

3. China can improve its global standing and U.S. relations by joining the fight against Islamic State.

By Dingding Chen in the Diplomat

4. The economic future of manufacturing is to be an incubator of innovation: “where new ideas become new products.”

By Nanette Byrnes in MIT Technology Review

5. In the future, a book could be a living thing.

By Wendy Smith in Publisher’s Weekly

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME medicine

China Fines GlaxoSmithKline $485 Million for Bribery

The pharma company admits it's at fault and will not appeal

After a one-day secret trial, a Chinese court has fined pharmaceutical company GlaxoSmithKline (GSK) $489 million for bribing hospitals and doctors to use their products.

According to the New York Times, the court also sentenced GSK’s former country manager Mark Reilly as well as four additional managers to prison time of up to four years. However, the sentences were suspended, and the managers will avoid prison with good behavior–though Reilly must leave the country. The is the largest ever corporate fine in China, reports the Wall Street Journal, though some analysts had expected the fine to be even higher.

GSK issued a statement of apology, writing:

GSK fully accepts the facts and evidence of the investigation, and the verdict of the Chinese judicial authorities. Furthermore, GSK sincerely apologizes to the Chinese patients, doctors and hospitals, and to the Chinese Government and the Chinese people. GSK deeply regrets the damage caused. GSK plc also apologizes for the harm caused to individuals who were illegally investigated by GSKCI [GSK China Investment Co. Ltd].

You can read GSK’s full apology here.

GSK says they fully cooperated with the authorities and are reducing and changing the nature of their activities with health professionals, as well as growing the process the company uses to monitor payments and invoices. “We will also continue to invest directly in the country to support the government’s health care reform agenda and long-term plans for economic growth,” said GSK CEO, Sir Andrew Witty in a statement. The fine will come from existing cash resources, the company says.

According to IBISWorld Global Pharmaceuticals analyst Sarah Turk, GSK’s 3% market share in the global pharmaceuticals and medicine manufacturing industry will likely drop over the next five years, and the fine will significantly hinder the company’s research and development funding, thus increasing its competition with global companies like Pfizer and Novartis.

“As [GSK] seeks new investment opportunities in the coming years, the $489 million fine will limit the company’s leverage to acquire other companies and remain competitive in an industry that is increasingly looking for methods to harness new drug development pipelines,” writes Turk in an emailed statement. “Additionally, other pharmaceutical companies will likely tread carefully in the Chinese market, due to GSK’s fine possibly indicating that Chinese regulators are increasingly cracking down on corporate malpractice.”

This is not the first time GSK has been fined significantly for wrongdoing. In July 2012, the U.S. State Department fined the company $3 billion for marketing drugs for unapproved uses.

TIME medicine

Your Doctor Should Reveal Biases and Pharma Ties, Says Group

Should your doctor reveal their positions on contraception and whether they accept money from drug companies?

Studies have reported that around 94% of doctors have some sort of relationship with pharmaceutical companies. One study published in the New England Journal of Medicine found that more than one third of physician respondents received reimbursement from drug companies for costs associated with meetings or continuing education, and over a quarter received payments for enrolling patients in trials, or for consultations and lectures. Patients can already see if their doctor has received compensation from drug companies on ProPublica’s database, Dollars for Docs—but one physician wants to take that a step further.

Dr. Leana Wen, director of patient-centered care research at George Washington University recently launched “Who’s My Doctor,” a platform where doctors can sign a Total Transparency Manifesto and disclose what outside funding they receive, what proportion of their pay comes from where and, if they’re willing, details about their family, political affiliation and philosophy of practice. For instance, a woman may want to know how her doctor feels about contraception, or abortion, or early breast cancer screenings. Parents might want to know how a doctor feels about routine vaccination. They can also, of course, see which drug companies, if any, the doctor has ties to.

“Dozens of studies have shown that when docs receive money from drug companies—even a free lunch—it does affect prescription behavior,” she says. Indeed, despite doctors’ assurances that pharmaceutical relationships don’t interfere with patient care, other research and investigations has showed it does.

“As doctors we need to be able to establish and maintain that trust,” says Wen in an interview with TIME. “I think financial interest is a big problem. If we are ashamed to tell our patients about our financial conflicts of interest then we should question why we have them in the first place.” Wen spoke about her pledge at the TEDMed conference in early September. Part of her motivation came from watching her mother, who was battling breast cancer, discover that her physician was financially tied to the chemotherapy regimen he prescribed.

Not all doctors support the idea of asking physicians to declare personal preferences and background. Some posted criticisms about Wen’s platform when she launched it in spring 2014. “I devoted 12 years of my life to being a slave. I have loans and mortgages…. I depend on lunches from drug companies to serve patients,” wrote one doctor. Another commented: “I find it an invasion of my privacy to disclose where my income comes from. My patients don’t disclose their incomes to me.”

Other doctors are on-board, though. “I want doctors to see this as a positive thing for them and I want patients to be asking for it too,” says Wen. “This is the right thing to do.”

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