case study the johnson and johnson tylenol crisis

How Poisoned Tylenol Became a Crisis-Management Teaching Model

T he 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

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Right Attitudes

Ideas for Impact

Tylenol Made a Hero of Johnson & Johnson: A Timeless Crisis Management Case Study

March 11, 2021 By Nagesh Belludi Leave a Comment

Crisis needn’t strike a company solely because of its own neglect or disaster. Sometimes, situations emerge where the company can’t be blamed—but the company realizes quickly that it’ll get much blame if it fumbles the ball in its crisis-response.

Ever since cyanide-laced Extra-Strength Tylenol killed seven people in Chicago in 1982, corporate boards and business school students have studied the response of Johnson & Johnson (J&J,) Tylenol’s manufacturer, to learn how to handle crises . The culprits are still unknown almost 40 years later.

Successful Crisis Management: Full Responsibility, Proactive Stance

In 1982, Tylenol commanded 35 percent of the over-the-counter analgesic market in America. This over-the-counter painkiller was the drugmaker’s best-selling product, and it represented nearly 17 percent of J&J’s profits. When seven people died from consuming the tainted drug, Time magazine wrote of the tragedy’s victims,

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 nearby 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.”

A panic ensued about how widespread the contamination may be. Moreover, Americans started to question the safety of over-the-counter medications.

Advertising guru Jerry Della Femina declared Tylenol dead:

I don’t think they can ever sell another product under that name. There may be an advertising person who thinks he can solve this, and if they find him, I want to hire him because then I want him to turn our water cooler into a wine cooler.

The ‘Grand-Daddy’ of Good Crisis Response

• J&J acted quickly , with complete candidness about what had happened, and immediately sought to remove any source of danger based on the worst-case scenario. Within hours of learning of the deaths, J&J installed toll-free numbers for consumers to get information, sent alerts to healthcare providers nationwide, and stopped advertising the product. J&J recalled 31 million bottles of Tylenol capsules from store shelves and offered replacement products free of charge in the safer tablet form. J&J did not wait for evidence to see whether the contamination might be more widespread.
• J&J’s leadership was in the lead and seemed in full control throughout the crisis. James Burke , J&J’s chairman, was widely admired for his leadership to pull Tylenol capsules off the market and his forthrightness in dealing with the media. (The Tylenol crisis led the news every night on every station for six weeks.)
• J&J placed consumers first . J&J spent more than $100 million for the recall and relaunch of Tylenol. The stock had been trading near a 52-week high just before the tragedy, dropped for a time, but recovered to its highs only two months later.
• J&J accepted responsibility . Burke could have described the disaster in many different ways: as an assault on the company, as a problem somewhere in the process of getting Tylenol from J&J factories to retail stores, or as the acts of a crazed criminal.
• J&J sought to ensure that measures were taken to prevent as far as possible a recurrence of the problem. J&J introduced tamper-proof packaging (supported by an expanded media campaign) that would make it much more difficult for a similar incident to occur in the future.
• J&J presented itself prepared to handle the short-term damage in the name of consumer safety. That, more than anything else, established a basis for trust with their customers. Within a year of the disaster, J&J’s share of the analgesic market, which had fallen to 7 percent from 37 percent following the poisoning, had climbed back to 30 percent.

Business Principles Should Hold True in Good Times and Bad

When the second outbreak of poisoning occurred four years after the first, Burke went on national television to declare that J&J would only offer Tylenol in caplets, which could not be pulled apart and resealed without consumers knowing about it.

Burke received the Presidential Medal of Freedom in 2000. He was named one of history’s ten most outstanding CEOs by Fortune magazine in 2003. In Lasting Leadership: What You Can Learn from the Top 25 Business People of Our Times (2004,) Burke emphasized,

J&J credo has always stated that the company is responsible first to its customers, then to its employees, the community and the stockholders, in that order. The credo is all about the consumer. [When those seven deaths occurred,] the credo made it very clear at that point exactly what we were all about. It gave me the ammunition I needed to persuade shareholders and others to spend the $100 million on the recall. The credo helped sell it. Trust has been an operative word in my life. It embodies almost everything you can strive for that will help you to succeed. You tell me any human relationship that works without trust, whether it is a marriage or a friendship or a social interaction; in the long run, the same thing is true about business.

Idea for Impact: A Crisis Makes a Leader

The first few days after any disaster or crisis can be a make-or-break time for a company’s and its leaders’ reputation. The urgency experienced during a crisis often gives leaders the go-ahead to enact change faster than ever before.

Admittedly, the Tylenol case study is more clear-cut than most crises because, from the get-go, it is clearly evident that criminals, not Johnson & Johnson, were responsible for the poisoning and the withdrawal of Tylenol from stores was comparatively easier to execute.

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Dr. Howard Markel Dr. Howard Markel

• Copy URL https://www.pbs.org/newshour/health/tylenol-murders-1982

How the Tylenol murders of 1982 changed the way we consume medication

Early on the morning of Sept. 29, 1982, a tragic, medical mystery began with a sore throat and a runny nose. It was then that Mary Kellerman, a 12-year-old girl from Elk Grove Village, a suburb of Chicago, told her mother and father about her symptoms. They gave her one extra-strength Tylenol capsule that, unbeknownst to them, was laced with the highly poisonous potassium cyanide. Mary was dead by 7 a.m. Within a week, her death would panic the entire nation. And only months later, it changed the way we purchase and consume over-the-counter medications.

That same day, a 27-year-old postal worker named Adam Janus of Arlington Heights, Illinois, died of what was initially thought to be a massive heart attack but turned out to be cyanide poisoning as well. His brother and sister-in-law, Stanley, 25, and Theresa, 19, of Lisle, Illinois, rushed to his home to console their loved ones. Both experienced throbbing headaches, a not uncommon response to a death in the family and each took a Tylenol extra-strength capsule or two from the same bottle Adam had used earlier in the day. Stanley died that very day and Theresa died two days later.

As a result of the crime, makers of Tylenol developed new product protection methods. Photo by Daniel Acker/Bloomberg via Getty Images

Over the next few days, three more strange deaths occurred: 35-year-old Mary McFarland of Elmhurst, Illinois, 35-year-old Paula Prince of Chicago, and 27-year-old Mary Weiner of Winfield, Illinois. All of them, it turned out, took Tylenol shortly before they died.

It was at this point, early October of 1982, that investigators made the connection between the poisoning deaths and Tylenol, the best-selling, non-prescription pain reliever sold in the United States at that time. The gelatin-based capsules were especially popular because they were slick and easy to swallow. Unfortunately, each victim swallowed a Tylenol capsule laced with A lethal dose of cyanide.

McNeil Consumer Products, a subsidiary of the health care giant, Johnson & Johnson, manufactured Tylenol. To its credit, the company took an active role with the media in issuing mass warning communications and immediately called for a massive recall of the more than 31 million bottles of Tylenol in circulation. Tainted capsules were discovered in early October in a few other grocery stores and drug stores in the Chicago area, but, fortunately, they had not yet been sold or consumed. McNeill and Johnson & Johnson offered replacement capsules to those who turned in pills already purchased and a reward for anyone with information leading to the apprehension of the individual or people involved in these random murders.

READ: The ‘awful’ work of the real doctors who inspired M*A*S*H

The case continued to be confusing to the police, the drug maker and the public at large. For example, Johnson & Johnson quickly established that the cyanide lacing occurred after cases of Tylenol left the factory. Someone, police hypothesized, must have taken bottles off the shelves of local grocers and drug stores in the Chicago area, laced the capsules with poison, and then returned the restored packages to the shelves to be purchased by the unknowing victims.

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To this day, however, the perpetrators of these murders have never been found.

One man, James Lewis, claiming to be the Tylenol killer wrote a “ransom” letter to Johnson & Johnson demanding $1 million in exchange for stopping the poisonings. After a lengthy cat and mouse game, police and federal investigators determined that Lewis lived in New York and had no demonstrable links to the Chicago events. That said, he was charged with extortion and sentenced to 20 years in prison. He was released in 1995 after serving only 13 years.

READ MORE: James Lewis, suspect in the 1982 Tylenol murders, dies at 76

Other “copy-cat” poisonings, involving Tylenol and other over-the-counter medications, cropped up again in the 1980s and early 1990s but these events were never as dramatic or as deadly as the 1982 Chicago-area deaths. Conspiracy theories about motives and suspects for all these heinous acts continue to be bandied about on the Internet to this day.

Before the 1982 crisis, Tylenol controlled more than 35 percent of the over-the-counter pain reliever market; only a few weeks after the murders, that number plummeted to less than 8 percent. The dire situation, both in terms of human life and business, made it imperative that the Johnson & Johnson executives respond swiftly and authoritatively.

For example, Johnson & Johnson developed new product protection methods and ironclad pledges to do better in protecting their consumers in the future. Working with FDA officials, they introduced a new tamper-proof packaging, which included foil seals and other features that made it obvious to a consumer if foul play had transpired. These packaging protections soon became the industry standard for all over-the-counter medications. The company also introduced price reductions and a new version of their pills — called the “caplet” — a tablet coated with slick, easy-to-swallow gelatin but far harder to tamper with than the older capsules which could be easily opened, laced with a contaminant, and then placed back in the older non-tamper-proof bottle.

Within a year, and after an investment of more than $100 million, Tylenol’s sales rebounded to its healthy past and it became, once again, the nation’s favorite over-the-counter pain reliever. Critics who had prematurely announced the death of the brand Tylenol were now praising the company’s handling of the matter. Indeed, the Johnson & Johnson recall became a classic case study in business schools across the nation.

In 1983, the U.S. Congress passed what was called “the Tylenol bill,” making it a federal offense to tamper with consumer products. In 1989, the FDA established federal guidelines for manufacturers to make all such products tamper-proof.

Sadly, the tragedies that resulted from the Tylenol poisonings can never be undone. But their deaths did inspire a series of important moves to make over-the-counter medications safer (albeit never 100 percent safe) for the hundreds of millions of people who buy them every year.

Editor’s note: This report has been updated to remove the reported amount of cyanide used.

Dr. Howard Markel writes a monthly column for the PBS NewsHour, highlighting momentous historical events that continue to shape modern medicine. He is the director of the Center for the History of Medicine and the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan and the author of “The Secret of Life:  Rosalind Franklin, James Watson, Francis Crick and the Discovery of DNA’s Double Helix” (W.W. Norton, September ’21).

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Honors Theses

Case study analysis: exploring johnson & johnson's 1982 tylenol contamination crisis and ongoing talcum powder crisis through the six principles of crisis and emergency risk communication.

Caroline Tibbs Follow

Date of Award

Spring 5-6-2024

Document Type

Undergraduate Thesis

Integrated Marketing Communication

First Advisor

Amanda Bradshaw

Second Advisor

Deborah Hall

Third Advisor

Josie Burks

Relational Format

Dissertation/Thesis

In 2002, the Center for Disease Control and Prevention (CDC) developed a new field of communication, called Crisis and Emergency Risk Communication (CERC). With the creation of this new field, the CDC developed a streamlined CERC guidebook in order to provide a standard for the crisis communication strategies and responses of specifically healthcare organizations, but any organization can benefit from utilizing the CERC framework. The CDC also identified six key principles of CERC, which are as follows: response time (“be first”), accuracy (“be right”), credibility (“be credible”), having empathy (“express empathy”), promotion of actions (“promote actions”), and respectfulness (“show respect”).

In a literature review, this thesis explores two case studies, the 1982 Johnson & Johnson Tylenol contamination crisis and the ongoing Johnson & Johnson talcum powder contamination crisis, through the lens of the six principles of CERC. Utilizing both a semi-structured guide and the “think aloud” interview approach, primary data was gathered qualitatively through interviews with 10 University of Mississippi integrated marketing communications students and through interviews with six communications professionals. These interviews were conducted to understand how both communications professionals and students describe the two Johnson & Johnson case studies and how the crisis response varied for each case study. Analysis of this data revealed seven themes that highlight the levels of success of Johnson & Johnson’s responses in adhering to the six CERC principles. Implications include that Johnson & Johnson’s responses to the Tylenol crisis were successful and that their responses to the talcum powder crisis were not successful.

Recommended Citation

Tibbs, Caroline, "Case Study Analysis: Exploring Johnson & Johnson's 1982 Tylenol Contamination Crisis and Ongoing Talcum Powder Crisis Through The Six Principles of Crisis and Emergency Risk Communication" (2024). Honors Theses . 3128. https://egrove.olemiss.edu/hon_thesis/3128

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School of Public Health

People, politics and poison: the tylenol® murders revisited forty years later.

About this story Heading link Copy link

Michael Petros, DrPH ’11, MPH ’84,  is a clinical assistant professor at the UIC School of Public Health and core faculty in SPH’s Doctor of Public Health Leadership (DrPH) program. Petros served 38 years at the City of Chicago and State of Illinois public health laboratories, first as a senior microbiologist in serology/virology and later, as chief of operations for newborn screening. During his tenure in the laboratory, Dr. Petros became a recognized expert in fluorescent microscopy and conducted training seminars for local health department laboratory staff. He developed quality control processes for high throughput population-focused screening technologies and contributed to national consensus documents on the subject. In this op-ed, he reflects on his experiences leading the public health response to the Tylenol murders of 1982.

Introduction Heading link Copy link

Wednesday, September 29, 1982 at 6:30am CDT, the nightmare that was to be known as the “Tylenol® Murders” began 1 . At first, the story focused in the Chicago/Cook County area but soon spread to the entire country and around the world.

The story would eventually involve law enforcement on local, state and federal levels, emergency responders, the medical examiner’s office, the hospital medical care system, and to its credit, local public health.

Once the story broke, the call volume at Illinois Poison Center (which normally averaged about 40-60 calls per 24 hours), approached 800 calls in a similar time period 2 .

The product in question was Extra Strength Tylenol® capsules, manufactured by the McNeil Consumer Healthcare division of Johnson & Johnson. Seven fatalities were linked to ingestion of this over-the-counter medicine. The victims (5 female, 2 male) ranged in age from 12 – 35 years. Three members of the same family succumbed after sharing the same bottle of capsules. The products were purchased at different retail locations in the Chicago area and were manufactured at two different out-of-state facilities (Pennsylvania and Texas). Clearly, the products were tampered with after manufacture. Analysis determined that the capsules were laced with crystals of potassium cyanide, which can be lethal within 15 minutes of ingestion. Potassium cyanide interferes with the electron transport chain in the mitochondria of cells and the body becomes unable to generate adenosine triphosphate for cellular respiration 3,4 .

Eventually, one individual was brought to justice, but not for the actual product tampering and poisoning. A week after the first deaths, a handwritten letter arrived at Johnson & Johnson headquarters. It read in-part: “ Since the cyanide is inside the gelatin, it is easy to get buyers to swallow the bitter pill. … So far, I have spent less than $50 and it takes me less than 10 minutes per bottle .” James William Lewis was accused of sending the letter to Johnson & Johnson demanding $1 million to stop the cyanide murders. Lewis was arrested, charged, tried and convicted of extortion and served more than ten years in federal prison 5 .

No further deaths beyond the seven were linked to this particular incident. However, concerns on the part of the public continued for some time after. It was reported that Halloween candy sales were down approximately 20 percent in 1982 6 .  “Copycat” incidents continued from time to time 7 .

Johnson & Johnson established a communication relationship with the Chicago Police Department, the Federal Bureau of Investigation and the US Food and Drug Administration. The company remained an active partner in the investigation 8 .

If there is any “good” to emerge from this incident, it is the increased protection offered by tamper-resistant packaging of consumer products such as over-the-counter medications and prepared food products.

The incident is also a case study in how a corporate entity could respond to a criminal incident, affecting confidence in a manufactured product. About 31 million bottles of Tylenol® capsules were removed from store shelves and recalled. The response by Johnson & Johnson became a model for crisis management. Johnson & Johnson’s approach was successful in that it was later able to re-release Tylenol® capsules in triple-sealed containers, now a pharmaceutical industry standard. Eventually, two-piece capsules were replaced with solid caplets.

Shortly thereafter, the so-called “Tylenol bill” was passed, making it a federal offense to tamper with products.  In 1989, the FDA established tamper-proof guidelines for consumer products 9 .

In 2011, the FBI requested DNA samples from Ted Kaczynski (AKA: the “Unabomber”), who is serving eight consecutive life sentences in federal prison for murder and related crimes 10 .  In 1982, Kaczynski occasionally stayed at his parents’ home in suburban Chicago 11 .

The case remains open and unsolved to this day 12 .

Author's reflections Heading link Copy link

On Friday, October 1, 1982, 48 hours after the first reported death, there was an emergency meeting for all the section chiefs of the Chicago Department of Health, Division of Laboratories. At this time, I was serving as the acting section chief of serology and virology.  The Division of Laboratories was located in the lower level of the R.J. Daley Center in downtown Chicago and consisted of approximately 80 laboratory professional and support staff, organized into the microbiology, virology/serology, clinical chemistry/hematology, chemistry/toxicology, hemoglobinopathy and gynecologic cytology sections.

We had all been following the escalating and alarming news stories about the multiple deaths, apparently being related to ingestion of adulterated Tylenol®. To those of us familiar with capacity of the various local laboratories (Chicago Police Crime Lab, Illinois Department of Public Health Toxicology Lab, Illinois State Police Crime Lab, etc.) including our own Chemistry/Toxicology unit, we knew that sooner or later, our labs would become involved.  Indeed, after a relatively brief discussion, the section chief team proposed a plan to provide support to local laboratories involved in the Tylenol® investigation. It was agreed that our team would be able to provide emergency “surge capacity” to the investigation for 48 uninterrupted hours. We would move to 12 hour shifts around the clock for the weekend, with re-evaluation on Monday October 4 th . Everyone was “on deck”, including clerical and support staff. Those of us section chiefs used our best people and leadership skills to mobilize our staff. We were successful. This spoke volumes about the dedicated nature of the skilled public servants we supervised.

For those 48 plus hours, we opened and checked innumerable containers of Extra Strength Tylenol®. Mayor Jane Byrne called a press conference to update Chicagoans on the situation and announced that all Tylenol® products would be removed from the store shelves in Chicago. The removed products were delivered to the our labs by Chicago Police and Health Department messengers.

Acetaminophen, the primary active ingredient in Tylenol®, is a white powder and should have been the only contents of the capsules. The tedious checking process consisted of physically pulling-apart capsules and looking for crystals of potassium cyanide.  While potassium cyanide has a distinct aroma (i.e., ‘bitter almonds’), this ability is genetic, and only about 50 percent of the population is able to detect that by smell 13 . It is also important to note that as group, cyanides are potential chemical weapons agents, and air concentrations of 200 parts per million can be rapidly fatal 14 .  So the painstaking process of carefully separating the sections of the capsules and visually inspecting the contents of thousands of those capsules was the order of the day.

On Monday, October 4, we re-evaluated the emergency situation. Doing this was critical because the daily routine work would be delivered to CDOH-DOL beginning mid-day. There was no additional surge capacity available to do the routine work and continuing the Tylenol® response. For perspective of the normal workload, each day, the Department of Laboratories processed approximately 1000 syphilis serology specimens, 1200-1400 gonorrhea cultures, 200 – 400 strep throat cultures, hundreds of pre-natal rubella tests, pediatric blood lead, hematology and clinical chemistry specimens, various food product complaints, routine milk quality tests and animal rabies tests involving human exposure 15 . Given the realities of daily throughput and turn-around-time commitments for analytical results, it was determined to continue a scaled-back Tylenol® response, but shift focus to the routine analytical responsibilities. “Scaled-back” being a relative term, as by this time, there was palpable panic in the public’s mind, so the department began receiving non-Tylenol® over-the-counter products, street drugs and related accoutrements, such as used syringes, razor blades and pipes. Triage at specimen receipt was instituted.

Gradually, Department of Laboratories testing life returned to normal over the next weeks. But the memories of those who were “there”, remain. Consumer products were subsequently marketed in tamper-resistant packaging. The question remains, “Why?”  Why would someone commit such a series of horrific, random acts? How could public health and law enforcement prepare to respond in the future?

On December 31, 1993, the Chicago Department of Health, Division of Laboratories ceased operations and most testing responsibilities transferred to the State of Illinois Public Health Laboratory. On that last day, there remained a secure storage room containing the Tylenol® investigation materials processed by the CDOH-DOL eleven years earlier, awaiting disposition. The person or persons who committed this act of domestic chemical terrorism remain unknown.

This article is dedicated to the staff of the Chicago Department of Health, Division of Laboratories, many now deceased, who rose to the call to protect and reassure our Chicago residents.

References Heading link Copy link

• https://www.chicagomag.com/Chicago-Magazine/October-2012/Chicago-Tylenol-Murders-An-Oral-History/
• https://ipcblog.org/2010/02/02/recollections-of-the-1982-chicago-tylenol%c2%ae-cyanide-poisonings/
• https://forensicsciencesociety.com/thedrip/the-cold-case-tylenol-murders
• https://www.discovermagazine.com/health/the-tylenol-murders-changed-the-way-we-take-medicine
• https://www.abajournal.com/magazine/article/chicago_tylenol_murders
• Victor, Daniel; Ortiz, Aimee (October 27, 2021). “That Tainted Halloween Candy Myth Just Won’t Go Away”. The New York Times.
• http://content.time.com/time/nation/article/0,8599,1878063,00.html
• Andrews, Robert V. (2005). “Crisis Communications and the Tylenol Poisonings”. In Heath, Robert (ed.). Encyclopedia of Public Relations. SAGE Publications, Inc. pg. 225–226. doi:10.4135/9781412952545.n105. ISBN 9780761927334.
• https://www.corboydemetrio.com/cases-tylenol-tampering-litigation
• Woolner, Ann (May 19, 2011). “FBI Wants Unabomber’s DNA for 1982 Tylenol Poisoning Probe” . Bloomberg News. Archived from the original on May 22, 2011 .
• “ FBI wants to test Unabomber DNA in Tylenol killings “ . Daily Herald. May 19, 2011. Archived from the original on June 24, 2011 . http://www.dailyherald.com/article/20110519/news/705199967
• https://archives.fbi.gov/archives/chicago/press-releases/2009/feb04_09.htm
• Jane’s Chem-Bio Handbook. 2 nd ed. Jane’s Information Group. 2002. pg 101.
• PDR Guide to Biological and Chemical Warfare Response, Thomson/Physicians’ Desk Reference, 2002. pg 55-56. ISBN: 1-56363-426-0
• 150 Years of Municipal Health Care in the City of Chicago. Official publication. Shirley Haas, Director of   Community Education, CDOH, editor.  1985.

A business journal from the Wharton School of the University of Pennsylvania

Tylenol and the Legacy of J&J’s James Burke

October 2, 2012 • 4 min read.

When seven people died from taking cyanide-laced Tylenol capsules in 1982, James Burke, then CEO of Johnson & Johnson, didn’t hesitate to take action. It’s a lesson some companies still haven’t learned.

In 1982, seven people died after taking cyanide-laced extra-strength Tylenol capsules sold in five Chicago stores. Before that happened, Tylenol, sold by J&J’s McNeil Consumer Products division, had 35% of the $1.2 billion analgesic market. After the deaths, J&J’s market share dropped to 7%.

Under Burke’s leadership, the company spent $100 million to recall 31 million bottles of Tylenol and re-launched the product two months later in tamper-proof packaging. Burke’s actions have become a legendary example of good crisis management, serving as the basis for case studies in numerous business schools and management books.

Burke not only saved the reputation of the company, but he also saved the brand as well. By mid-1983, Tylenol’s share of the analgesic market had climbed to 30%, reaching 35% by the end of the year.  

In a 2004 Wharton School Publishing Book titled, Lasting Leadership: What You Can Learn from the Top 25 Business People of Our Times , Burke emphasized the value of the J&J credo, dating back to the company’s founding in 1887, which stated that the company is responsible first to its customers, then to its employees, the community and the stockholders, in that order. “The credo is all about the consumer,” Burke said. When those seven deaths occurred, “the credo made it very clear at that point exactly what we were all about. It gave me the ammunition I needed to persuade shareholders and others to spend the $100 million on the recall. The credo helped sell it.”

In his interview for Lasting Leadership , Burke also spoke about trust. “Trust has been an operative word in my life. [It] embodies almost everything you can strive for that will help you to succeed. You tell me any human relationship that works without trust, whether it is a marriage or a friendship or a social interaction; in the long run, the same thing is true about business.”

Ironically, Johnson & Johnson has recently experienced a number of setbacks that “have caused many to question whether the firm has lost sight of that credo,” according to a Knowledge at Wharton article earlier this year. The company’s problems with plants in Fort Washington, Pa., Lancaster, Pa., and Puerto Rico — the sites associated with recalls of over-the-counter products like Benadryl and Children’s Tylenol – “dragged on for years,” the article notes. Two hip devices were recalled in 2010 for post-surgical complications, and the company agreed to pay $158 million to the state of Texas to settle claims it improperly marketed the anti-psychotic drug Risperdal to some patients. Other suits surrounding the marketing of this drug are ongoing. Recalls of surgical sutures and contact lenses have been announced as well.

Years earlier, as Lasting Leadership noted, other companies had demonstrated what came to be seen as poor judgment in the way they handled defective product incidents. For example, Coca-Cola had mismanaged the “contaminated can” incident in Europe in 1999; Intel had initially failed to respond quickly to the calculation errors embedded in its Pentium chip in 1994, and Firestone had initially refused to accept responsibility for SUV roll-overs caused by poorly manufactured tires in 2000.

Burke’s actions were the opposite. According to media reports at the time, the Tylenol crisis led the news every night on every station for six weeks. Burke, however, met the challenge head on, contacting the chief of each network’s news divisions in order to keep them informed. He also met with the directors of the FBI and the FDA. “There were many people in the company who felt there was no possible way to save the brand, that it was the end of Tylenol,” Burke said. “But the fact is, I had confidence in J&J and its reputation, and also confidence in the public to respond to what was right. It helped turn Tylenol into a billion-dollar business.”

The person who placed the cyanide in the Tylenol capsules was never found.

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Leadership in Times of Crisis

Robert l. kane.

1 From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School.

Jennifer M. Egan

Kevin c. chung.

In the wake of the death toll resulting from coronavirus disease of 2019 (COVID-19), in addition to the economic turmoil and strain on our health care systems, plastic surgeons are taking a hard look at their role in crisis preparedness and how they can contribute to crisis response policies in their own health care teams. Leaders in the specialty are charged with developing new clinical policies, identifying weaknesses in crisis preparation, and ensuring survival of private practices that face untenable financial challenges. It is critical that plastic surgery builds on the lessons learned over the past tumultuous year to emerge stronger and more prepared for subsequent waves of COVID-19. In addition, this global health crisis presents a timely opportunity to reexamine how plastic surgeons can display effective leadership during times of uncertainty and stress. Some may choose to emulate the traits and policies of leaders who are navigating the COVID-19 crisis effectively. Specifically, the national leaders who offer empathy, transparent communication, and decisive action have maintained high public approval throughout the COVID-19 crisis, while aggressively controlling viral spread. Crises are an inevitable aspect of modern society and medicine. Plastic surgeons can learn from this pandemic to better prepare for future turmoil.

CRISIS: HERE TO STAY

In a matter of weeks, coronavirus disease of 2019 (COVID-19) swept across the United States and disrupted nearly every aspect of health care delivery. 1 By the time the virus received its official name, SARS-CoV-2, on February 11, 2020, 2 community spread in the United States was well underway. 3 By March 18, the Centers for Medicare & Medicaid Services declared that all nonemergent surgical, medical, and dental procedures should be suspended until further notice; the American Society of Plastic Surgeons issued similar recommendations the following day (Fig. ​ (Fig.1 1 ). 4 Amid shortages of personal protective equipment and unclear COVID-19 testing guidelines, health care leaders grappled with the transition to telemedicine and the transformation of operating rooms into intensive care beds. 5 With evidence pointing toward subsequent waves of the illness in the coming months, 6 it is clear that the COVID-19 crisis will continue to bring new challenges that test the strength of leaders across all medical disciplines.

Timeline of COVID-19 events relevant to plastic surgeons. WHO , World Health Organization; AAMC , Association of American Medical Colleges; CMS , Centers for Medicare & Medicaid Services; ASPS , American Society of Plastic Surgeons; CARES , Coronavirus Aid, Relief, and Economic Security Act; ACS , American College of Surgeons; ASA , American Society of Anesthesiologists; AORN , American Association of Perioperative Registered Nurses; AHA , American Hospital Association.

As the pandemic unfolds, industries and organizations find themselves scrambling to mitigate economic losses, adopt new business models, and protect employee safety. 7 These challenges are particularly evident in the field of plastic surgery, where private practices are experiencing financial hardship and logistical challenges. 8 After nonemergent case volume plummeted in March, the resulting economic losses left private practice surgeons in a dilemma; they could furlough valued team members or face unsustainable overhead costs. 8 Some plastic surgeons have compared this bleak climate to that seen in the 2008 economic recession. Others fear it may be worse, given the added component of medical supply shortages, the increased cost of protective equipment, and a more immediate drop in revenue. 9 There is further concern about the unprecedented backlog of nonemergent surgical procedures that were postponed following the Centers for Medicare & Medicaid Services recommendations. 5 , 9 With restrictions slowly lifting, plastic surgery leaders have the responsibility to develop more robust surge capacity protocols in anticipation of future waves of COVID-19. Ethical considerations are necessary not only to determine which patients should receive care first, but also to weigh the risks and benefits of potential COVID-19 exposure in the clinical setting. 5 In addition, new protocols must be developed to guide surgeons on how and when to safely deescalate these surge capacity measures. 5 As leaders in health care, plastic surgeons are certainly being put to the test.

Despite the tragedy and turmoil, the COVID-19 pandemic presents opportunities for growth and reflection. This is a wake-up call for leaders of all backgrounds not only to reexamine their ability to prepare for and respond to crisis, but also to accept crisis as an unavoidable aspect of society. Effective leadership will be a critical determinant in curtailing the damage, disruption, and loss of life across the world. This will place an even greater spotlight on those leaders who have what it takes to mitigate the many downstream consequences of COVID-19. Therefore, we compiled this article to review the central challenges that leaders face during crisis. We also discuss effective leadership traits and examine the connection between leadership style and crisis outcome by drawing on real-world examples. We wish to impart relevant and engaging leadership principles that facilitate crisis management across plastic surgery subspecialties and practice settings.

LEADERSHIP PRINCIPLES FOR EFFECTIVE CRISIS RESPONSE

A crisis creates a series of conditions that test the limits of teams and organizations, often forcing leaders to reexamine their core values. 10 The word “crisis” broadly describes a low-probability event that has high potential for serious consequences. 11 Crises are time-sensitive, and as the clock ticks, the window to achieve a successful outcome closes. To make matters more challenging, the unexpected and often unprecedented nature of a crisis means that reliable information to assist decision-making is scarce. 11 Leaders must grapple with uncertainty surrounding the cause and the solution to the crisis. Considered together, these elements create a tumultuous storm through which leaders must navigate.

To lead effectively during a crisis, it is beneficial to examine how a crisis impacts team dynamics. 12 Given the high degree of uncertainty surrounding a crisis, leaders may feel that they are losing control. Therefore, some may reflexively overcompensate for this loss and attempt to control as many facets of the team as possible. 12 However, this overreliance on centralizing decisions and tasks, instead of delegating, can produce massive inefficiencies in crisis response. 13 Simply put, micromanaging may restore the leader’s sense of control at the expense of the team’s efficiency, which delays implementation of effective strategies. Leaders may also be tempted to switch to a survival mode. 14 In this scenario, all energy and focus are directed toward minimizing the immediate threat, protecting reputation, and cutting costs. 14 Although this leadership mentality can be necessary in the short-term response to crisis, it may marginalize the emotional needs of the team and the public, who are experiencing panic, isolation, anxiety, and helplessness. 14 In addition, a persistent survival mentality can undermine the team’s sense of purpose and long-term mission.

Modern crises unfold in front of a worldwide audience because of the rise of the 24-hour news cycle and increased access to media. 15 Therefore, today’s leaders must not only contend with the crisis itself, but also navigate scrutiny in real time; minute-to-minute updates can make or break public trust. 15 This intense spotlight might tempt leaders to avoid blame and escape accountability for a crisis. These self-interested tendencies can foster an “every man for himself” mentality that sows mistrust among team members. 16 Consequently, the leader’s communication style and degree of consistency shape the team’s morale and guide public perception of the leader’s response. 17 , 18 Crisis researchers recognize that leaders who routinely deliver honest and empathetic communication are most effective during crisis. 19 Although it is challenging to remain transparent about bad news and setbacks as a crisis develops, the payoff is that the team and the public perceive the leader as authentic. 19 Thus, it is necessary that leaders avoid downplaying credible threats and overpromising positive outcomes that they know to be unrealistic. In addition, displays of genuine empathy for those affected by the crisis reflect self-awareness and acknowledgement of peripheral stakeholders (Table ​ (Table1 1 ), 20 , 21 not just their immediate organization. Table ​ Table2 2 offers a summary of the leadership principles that are linked with successful crisis response. 12

Examples of Empathy and Emotional Intelligence in Crisis Response

FBI, Federal Bureau of Investigation.

Summary of Leadership Pearls and Pitfalls for an Effective Response to Crisis *

*Adapted from Burnison G, Korn Ferry. A word from the CEO: Leading in a crisis. Available at: https://www.kornferry.com/insights/articles/burnison-coronavirus-leadership-crisis . Accessed May 30, 2020.

THE PAST INFORMS THE PRESENT

Research on crisis management and response will prove instrumental to inform future health care policies and business models in the aftermath of COVID-19. However, the field of crisis management research is relatively young and will likely evolve throughout the pandemic. The initial interest in formally studying crisis management was sparked by a series of man-made disasters in the 1980s, including the Chernobyl and Three Mile Island nuclear disasters. 10 Around this time, crisis researchers argued that the incidence of crises was steadily multiplying as societies became increasingly industrialized, interdependent, and technologically advanced. 10 , 15 In plastic surgery, this decade was marked by the first of many crises in the breast implant industry.

Case reports of women developing autoimmune diseases following breast augmentation with silicone implants were first documented in 1982. 22 In the decade that followed, increased publicity and a growing number of women reporting adverse outcomes culminated in a class action lawsuit against implant manufacturer Dow Corning. 22 Although the claims lacked robust scientific evidence, the leadership at Dow Corning handled the crisis poorly by delaying their disclosure of product safety information and failing to assume responsibility early on. 23 This poor communication with the public exacerbated the negative media coverage of silicone breast implants, incited panic, and spurred further litigation amid insufficient safety data from implant manufacturers. 24 In 1992, the U.S. Food and Drug Administration issued a voluntary moratorium on silicone breast implants, a ban that was opposed by the American Medical Association and other professional societies. 25

Evidence demonstrates that crises are becoming more common in modern society. 10 , 15 Therefore, experts recommend that crises be reframed as continuous, compounding events, instead of singular entities. 11 , 15 , 24 With this mindset, we can recognize the “incubation period” of a crisis. 25 In this critical window, subtle signals and warnings provide leaders with opportunities for early intervention to avoid disaster. 25 Therefore, leaders who declare “we never could have predicted this” or “no one saw this coming” may find themselves facing greater scrutiny, particularly if the leader failed to recognize or heed the warning signs. Effective crisis management requires proactive surveillance strategies to prevent crisis, in addition to mitigation efforts once a crisis arrives. 11

Recent studies suggest that overhauling our approach to crisis response is long overdue. In 2018, consulting firm Deloitte conducted a global survey of over 500 corporate crisis managers. 26 Although the study found that 90 percent of surveyed corporations were confident they could navigate a crisis, only 17 percent of these organizations had conducted a simulation to evaluate their preparedness. 26 Similarly, an international crisis management consultant firm surveyed 200 organizations and found that approximately 40 percent lacked a crisis management plan. 27 Of the companies that did have a plan in place, nearly 50 percent reported that the plan was not up to date. 27 Although leaders and administrators invest in crisis management plans to maximize their preparedness, these contingency efforts frequently fall short of their goals, and few appear to be robust. 28

When leaders fail to learn from past mistakes, or fail to act on warning signs, the results can be catastrophic. In 2019, the U.S. Department of Health and Human Services staged a series of exercises simulating a severe viral pandemic. 29 The simulation, named “Crimson Contagion,” presented a scenario where tourists caught a respiratory virus while traveling in China and subsequently returned to the United States. 29 Crimson Contagion was conducted to determine the capability of multiple levels of government to respond to a global health crisis and provide an opportunity to practice response actions. 29 , 30 The exercise forecasted that over 110 million Americans would contract the virus, resulting in 7.7 million hospitalizations and 586,000 deaths. 29 The exercise ultimately revealed the limited capacity of the government to respond to such an event. Key findings demonstrated that federal agencies lacked the funds, coordination, and resources to facilitate an effective response to a viral pandemic. 29 Crimson Contagion concluded several months before the COVID-19 outbreak and accurately predicted many of the problems the United States is currently facing. Simply conducting an exercise to identify gaps in crisis preparedness is not enough; leaders must be resolute in taking steps to prevent the crisis from occurring and embrace decisiveness.

Perhaps the most underappreciated aspect of effective crisis response is how leaders handle the aftermath, and the extent to which they capitalize on the lessons learned. 30 Although the breast implant industry has faced numerous crises, improvements in regulatory and quality control practices have lagged behind. 22 Following the Dow Corning breast implant scandal in the 1980s, the second major crisis in the industry surfaced in 2011, when cheap, nonmedical grade silicone gel breast implants manufactured by Poly Implant Prothèse were linked to high rates of premature rupture. 31 Although European regulatory agencies were aware as early as 2001 that these adverse events were taking place, it was not until 2010 that the United Kingdom and France suspended the sale of Poly Implant Prothèse silicone gel breast implants. 22 It is estimated that breast augmentations using Poly Implant Prothèse silicone gel implants were performed in over 300,000 women across 65 countries. 22 From this and other crises, it is clear that identifying our weaknesses is only half the battle. Translating new knowledge into targeted actions is critical to close the loop and minimize the chance that a similar crisis will arise again. 30

The Poly Implant Prothèse breast implant crisis resulted in the establishment of opt-out breast implant registries that are supported by international collaborations. 22 As some are concerned that the next crisis in this industry may be breast-implant associated anaplastic large-cell lymphoma (BIA-ALCL), efforts to maintain breast implant registries will produce reliable data surrounding the risk and incidence of this disease. Textured implants and those with high surface areas have been implicated in cases of BIA-ALCL. 22 Prospective data collection on BIA-ALCL demonstrates that plastic surgery leaders are leveraging the lessons learned from past crises to anticipate rather than to react to these potential threats. 32 In 2012, the American Society of Plastic Surgeons partnered with the U.S. Food and Drug Administration and the Plastic Surgery Foundation to develop the Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE). 32 Although arguments have been made for banning textured implants, the availability of high-quality, prospective data has provided regulatory agencies with reliable evidence to dismiss these calls. 22 Data generated from the Plastic Surgery Foundation to develop PROFILE show that the estimated risk of developing BIA-ALCL for women with implants is one to three per 1 million per year. 33 Painful as it may be, a crisis is a wake-up call for leaders to spring into action and initiate growth.

“Crisis in Plastic Surgery” is the title of a 1967 editorial published in Plastic and Reconstructive Surgery . 34 The article details the author’s concern that a surge in scientific discovery was creating a disconnect between the academic and practicing plastic surgeon. 34 In short, the busy practitioner could not keep up with the pace of academic research. Today, plastic surgery faces a new crisis that makes its prior dilemmas pale in comparison; the COVID-19 pandemic may be the largest test of plastic surgery leadership witnessed in recent memory.

During the current pandemic, the responses of leaders have varied. The U.S. response to COVID-19 has been plagued by confusion and shortcomings identified in the Crimson Contagion simulation 1 year ago. 35 Federal, state, and local officials delivered conflicting messages, hampering a coordinated national response. 36 On the other side of the world, leaders in New Zealand have received acclaim for aggressively flattening the curve. 37 On March 21, 2020, Prime Minister Jacinda Ardern unveiled plans for a four-level COVID-19 alert system. 38 This strategy was adapted from the wildfire risk system that was already well known to New Zealanders, creating a familiar model for the population to understand. The four-level alert system clearly illustrated how the nation’s response would escalate, 39 and provided citizens with an understanding of the potential policy changes. 38 When the number of New Zealand’s cases quadrupled in the span of 4 days, the alert system was raised to the highest level, activating a nationwide shelter-in-place. 39 In addition, Ardern effectively communicated the importance of tough restrictions that the public understood and accepted, and her displays of empathy have been credited with bringing the nation together during the COVID-19 crisis. 37 The prime minister was routinely visible to the public on Facebook Live chats, where she made efforts to recognize the strain that social distancing was placing on families. 37

Ardern’s ability to act decisively, demonstrate empathy, communicate effectively, and instill solidarity has been cited as instrumental in controlling COVID-19 transmission in New Zealand. 37 It is inspiring to see that these characteristics are also visible in the response of plastic surgery leaders to this crisis. Shortly after the World Health Organization officially declared COVID-19 a pandemic, the American Society of Plastic Surgeons partnered with the Federal Emergency Management Agency to set up supply chains for plastic surgeons to donate ventilators and personal protective equipment from private practices to support hospitals in need. 40 By March 26, the American Society of Plastic Surgeons had procured 6 million N95 masks and over 20,000 surgical masks for medical centers in New York City, a region that faced dire personal protective equipment supply shortages early in the pandemic’s course. 8 State and local governments in Illinois, Michigan, New Jersey, and New York also directly collaborated with American Society of Plastic Surgeons leadership to allocate ventilator and medical supply donations to hospitals with the greatest need. These swift decisions enabled rapid mobilization of supplies and put plastic surgeons in a position to stand united in responding to the COVID-19 threat. In addition, the American Society of Plastic Surgeons has remained transparent about the economic hardships and drastic changes that its members will face in the coming months and has routinely communicated strategies to guide its members through this tumultuous time. A wealth of online resources from the American Society of Plastic Surgeons is available to assist with core issues that plastic surgeons must confront: recommendations for safely resuming elective procedures, options for private practices to maintain financial solvency, and strategies for maximizing the potential of telemedicine. 40

Information surrounding SARS-CoV-2 is constantly evolving and proliferating. This pandemic exemplifies the need for health care leaders to consistently deliver the facts during a crisis, particularly in the face of emerging COVID-19 misinformation campaigns that engender fear and confusion. Health care leadership must routinely and openly communicate with their teams and the public, and provide recommendations and policy updates that are specific and clear. Furthermore, health care leaders should acknowledge the emotional toll this crisis has taken on their workforce and offer an outlet for colleagues to express themselves. Recognition and empathy for feelings of anxiety and isolation among health care teams is particularly relevant, considering the ongoing social distancing requirements and persistent fear of bringing the virus home to family members. Certain hospitals have responded by implementing weekly social hours and scheduled time for virtual interaction among team members. To assist hospital workers with childcare needs, the University of Washington developed a registry of medical students, family, and friends who are available to help. 41 These initiatives reflect leadership that effectively used emotional intelligence in times of crisis.

Today’s leaders cannot afford to ignore the lessons learned from crisis. Surviving the crisis should no longer be viewed as the finish line. Instead, we must identify avenues for change, invest in new preventive strategies, and commit to following through on our goals. Although crises may appear to occur out of nowhere, this is rarely the case; signs and signals are typically present long before the crisis manifests. Our leaders must not only prepare for how to act when crisis occurs, but pledge to actively surveil, detect red flags, and sound the alarm for future crises. In addition, leaders must communicate with candor, as public trust is crucial to positive outcomes. The most effective leaders display empathy and maintain transparency at all costs, even if this means admitting setbacks or breaking difficult news.

Disclosure: Dr. Chung receives funding from the National Institutes of Health and book royalties from Wolters Kluwer and Elsevier and is a consultant for Axogen. He is a consultant for Axogen and Integra. The remaining authors have no financial interest to disclose. No funding was received for this article.

Johnson & Johnson and Tylenol - Crisis Management Case Study

08 September 2008

Crisis need not strike a company purely as a result of its own negligence or misadventure. Often, a situation is created which cannot be blamed on the company - but the company finds out pretty quickly that it takes a huge amount of blame if it fumbles the ball in its response.

One of the classic tales of how a company can get it right is that of Johnson & Johnson, and the company's response to the Tylenol poisoning.

What happened

In 1982, Johnson & Johnson's Tylenol medication commanded 35 per cent of the US over-the-counter analgesic market - representing something like 15 per cent of the company's profits.

Unfortunately, at that point one individual succeeded in lacing the drug with cyanide. Seven people died as a result, and a widespread panic ensued about how widespread the contamination might be.

By the end of the episode, everyone knew that Tylenol was associated with the scare. The company's market value fell by $1bn as a result.

When the same situation happened in 1986, the company had learned its lessons well. It acted quickly - ordering that Tylenol should be recalled from every outlet - not just those in the state where it had been tampered with. Not only that, but the company decided the product would not be re-established on the shelves until something had been done to provide better product protection.

As a result, Johnson & Johnson developed the tamperproof packaging that would make it much more difficult for a similar incident to occur in future.

Cost and benefit

The cost was a high one. In addition to the impact on the company's share price when the crisis first hit, the lost production and destroyed goods as a result of the recall were considerable.

However, the company won praise for its quick and appropriate action. Having sidestepped the position others have found themselves in - of having been slow to act in the face of consumer concern - they achieved the status of consumer champion.

Within five months of the disaster, the company had recovered 70% of its market share for the drug - and the fact this went on to improve over time showed that the company had succeeded in preserving the long term value of the brand. Companies such as Perrier, who had been criticised for less adept handling of a crisis, found their reputation damaged for as long as five years after an incident.

In fact, there is some evidence that it was rewarded by consumers who were so reassured by the steps taken that they switched from other painkillers to Tylenol.

The features that made Johnson & Johnson's handling of the crisis a success included the following:

• They acted quickly, with complete openness about what had happened, and immediately sought to remove any source of danger based on the worst case scenario - not waiting for evidence to see whether the contamination might be more widespread
• Having acted quickly, they then sought to ensure that measures were taken which would prevent as far as possible a recurrence of the problem
• They showed themselves to be prepared to bear the short term cost in the name of consumer safety. That more than anything else established a basis for trust with their customers

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Why values matter in business: five key lessons from Tylenol Crisis from the “Tylenol Man” himself

Alan Hilburg is credited with the textbook case for successful management of a reputational crisis. Three decades back, the US-based communications guru crafted what was then an extremely innovative response to the famous Tylenol Crisis. The decision to remove $100m worth of the pain killers off shelves worldwide initially drew criticism as a massive over-reaction. That soon changed to praise for not only the right moral decision, but a coup for a business that showed it put people above profits. In its actions not just words. When he was in SA recently, the “Tylenol Man” appeared on CNBC Africa Power Lunch, where I asked him for some suggestions on how to handle reputational challenges this country faces. He later agreed to write a piece for Biznews.com. In it he takes us back to the disaster which Johnson & Johnson turned to triumph – and reflects on how its approach is more relevant than ever today. – AH  

By Alan Hilburg*

Johnson & Johnson recalled all of its product and over the following week, every Tylenol product) was removed from every store around the world and destroyed. That’s all 31 million capsules values at $100 million.

The Tylenol crises soon became the benchmark, the gold standard of how to view and manage crises.  More importantly, Tylenol is really the benchmark on why values matter. The Tylenol success story is currently the most widely taught case study of effective crises management in business schools in the US.

It is remarkable, but through more than 200 crises I’ve been involved with, every CEO had one common objective. They say, “We want to come through it like Johnson & Johnson’s Tylenol.” More than merely surviving the crisis, Tylenol demonstrates how crises, when well managed, build a stronger business, culture and reputation. Crises tell you that something is wrong that needs to be fixed. It’s, therefore, an opportunity to be better. As former US President Kennedy said, “Crises are opportunities in waiting.”

The company embarked on a two pronged strategy built around two key questions. How to return a safer product to the marketplace and how to earn back the trust of fearful customers?

The solution was not limited to developing safer packing for Tylenol, but it looked at how to address the more important issue of consumer confidence in product safety. As a result, the Johnson & Johnson team challenged itself to revolutionise packaging.  The product safety solution was also the catalyst for reversing consumer fear and winning back trust.

Larry Foster, Corporate Vice President of Public Relations at Johnson & Johnson said, in reflecting on the astute management of the crises, “What began as Johnsons & Johnson’s darkest hour turned out to be its brightest in terms of corporate reputation.”  When probed further, did you respond to a plan?  His response was visionary.

“No, not really.  We responded from our values,” he said.  The company’s values, written in the mid-1940’s by Robert Wood Johnson, stated that the company‘s responsibilities were to the consumers and medical professionals using its products, employees, the communities where its people work and live, and its stockholders. Therefore, it was essential to maintain the safety of its publics to ensure business continuity. Johnson & Johnson’s responsibility to its publics became the compass which guided the company’s decisions.

Chairman James Burke appeared on commercials, did more than 50 interviews and was the chief trust-builder. A press event was held concurrently by satellite in 100 cities in the US to introduce the new packaging, a new technology innovation in itself for its time.

Tylenol was re-launched with a revolutionary tamper proof packaging seal and introduced caplets. The solution, however, was less about innovative packaging or a great crises plan. It was more about a crises solution that focused on public safety and consumer peace of mind.  Innovative packaging was a rational driven solution.  Public safety and peace of mind was the emotional driven solution which, from more than 200 crises I’ve managed, always resonates with customers or victims.

What is also significant is that while a crises plan protects you brand and reputation, crises are more about the victims. It’s what I refer to as an “outside- in” instead of “inside-out” viewpoint. I’ve seen this cardinal mistake being made time and time again, most recently in the BP oil disaster in the Gulf of Mexico when CEO Tony Howard famously proclaimed, “There’s no one who wants this over more than I do. I would like my life back.”

Tylenol’s market share spiked from 33% before the crisis to 48% 90 days after the re-launch. Consumer trust in Tylenol increased three fold compared to the period prior to the crisis, restoring confidence in the brand.

So what are the five key learning from Tylenol’s experience?

1.   Values based brands outperform non-values based brands on trust, credibility and listenability. In other words, great companies and great brands stand on a platform of great values. In a crises I’d rather defend the values than the facts.

2. Crisis management is not about public relations driven ‘damage control’. It’s about business continuity. About affirmative strategic, business-centric action with a strong focus on the victims in a crises.

3. Assume responsibility for the solution, even if you don’t have to, because it’s about the publics’ trust in your brand and the test of your character.

4.  Act quickly, honestly and decisively.

5. Good behavior delivers great returns. Remember the high cost of low trust.

Nothing good happens without trust.  One of the most overlooked concepts in crisis management and mitigation is forgetting about the ‘speed of trust .’  It’s a concept that reflects the speed of gaining or losing the trust that communities have in your brand.  In crisis management, trust changes everything.  Why?  Because it’s the only thing that means everything.

* Alan Hilburg is President of Hilburg Associates SA a global specialist on crisis mitigation and management. He is the author of two New York Times best-sellers on leadership; Twelve Hats of a Company President and Russell Rules: Eleven Lessons in Leadership From the Greatest Winner of the 20th Century.

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Johnson & Johnson: The Tylenol Tragedy

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How Did Johnson and Johnson's Corporate Responsibility Policy Pay Off in 1982?

Johnson & Johnson is one of the largest and most successful companies in the world, and Tylenol is one of its most popular brands of medicine. In late September 1982, Johnson & Johnson recalled all of its Tylenol products after seven people in the Chicago area died after taking Extra-Strength Tylenol capsules. The company's chair at the time, James E. Burke, abided by corporate responsibility and made the difficult and expensive decision to recall 30 million Tylenol products voluntarily. This cost the company over $100 million.

How did Johnson and Johnson's commitment to corporate social responsibility remedy the situation and place the company in a positive light, even after suffering a financial loss by their swift actions to fix the problem?

Corporate Social Responsibility

Corporate social responsibility is part of a company's business model. It focuses on a company taking accountability for all of the decisions it makes as well as the impact that all of its goods and services have. It concentrates on a business being socially accountable to itself, the public, and all stakeholders .

A strong corporate social responsibility policy is good for a company's brand . If the company takes responsibility for all of its actions that impact all areas of society as a whole, including economic, environmental, and social, it can be seen in a positive light that individuals are happy and comfortable doing business with. In the long term, this helps the growth of the company.

Corporate social responsibility does not only need to include the day-to-day operations of a business but can also include any volunteer work the company does or philanthropy projects it is a part of.

Johnson & Johnson's Product Recall

Johnson & Johnson was not deemed responsible for the contamination of its product. The pills were tampered with after the products had reached the market shelves. The perpetrator(s) introduced enough potassium cyanide in each altered capsule to kill thousands of people. This crime caused nationwide panic, copycat crimes, and even the suspicion that Halloween candy might be poisoned as well. No one was ever found guilty of adding the poison into the capsules. Time magazine lists this as one of its top unsolved crimes.

The company's actions epitomized the true meaning of corporate social responsibility. Even though Tylenol products were generating approximately 17% of Johnson & Johnson's annual income, the company acted quickly and decisively to remedy the situation. It removed the products from shelves, offering refunds and safer tablets as replacements, free of charge.

Chair Burke adhered to the company's credo that outlines its ideal of corporate social responsibility. The first sentence of this, written by former chair Robert Wood Johnson, states, "We believe our first responsibility is to the doctors, nurses, and patients, to mothers and fathers, and all others who use our products and services."

The end result of these incidents was that Johnson & Johnson became the first manufacturer to begin using tamper-proof packaging. When Tylenol products were reintroduced into the market two months later, they included seals around and beneath a child-proof cap. The company also launched an extensive marketing campaign touting the new packaging.

Many believed these events would deal a devastating blow to Johnson & Johnson, but the company's quick, honest, and responsible handling of the incident was viewed extremely positively by both the general public and investors. As a result, the company quickly recovered from the financial losses incurred, and regained the trust of consumers.

The Bottom Line

Corporate social responsibility is when a company takes ownership of the impact it has on the larger public and all of its stakeholders. It includes social, economic, and environmental issues that a company attempts to have a positive effect on.

Johnson & Johnson taking ownership of the situation that arose with its Extra-Strength Tylenol product is one of the best examples of corporate social responsibility, where a company takes ownership of its own product, even if the issue was not caused by the company, and demonstrates leadership in rectifying the situation.

Though in the short run, fixing the situation as Johnson & Johnson did, can be financially devastating to a company, in the long run, it creates goodwill with the public and stakeholders, painting the company in a positive light, that inadvertently sets it up for financial success.

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Johnson & Johnson: The Tylenol Tragedy

Johnson & Johnson: The Tylenol Tragedy ^ 583043

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Product Description

Publication Date: October 12, 1982

Industry: Pharmaceutical industry

Source: Harvard Business School

In October 1982, Johnson & Johnson was confronted with a major crisis when seven deaths were attributed to poisoned Tylenol. The case reviews the facts as known a week after the incident occurred, and raises a wide range of questions regarding consumer behavior, corporate responsibility, and competitive reaction.

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Andrea's Blog

Welcome to my comm 100n blog for summer 2022 :d, the tylenol crisis: a mini case study.

On September 29, 1982, 12-year-old Mary Kellerman from Chicago, Illinois passed away after taking an extra-strength Tylenol capsule (“Chicago Tylenol Murders”). Following soon after, multiple Chicago residents would also die from the same source. Seven people had died before the cause was found- the Tylenol capsules they took were all poisoned with cyanide. According to available evidence, an unidentified assailant had removed Tylenol bottles from their shelves, enclosed cyanide within the capsules, and placed the reassembled bottles back on the shelf (“Chicago Tylenol Murders”).

Johnson & Johnson got word of the situation through a Chicago news reporter and immediately took action. A seven-member crisis communication team was composed, and this group would initiate all internal and external affairs regarding the incident (Berge). The first thing they did was recall all Tylenol products and halt production- they then made sure to involve a variety of people and organizations to best address the problem (Berge). News companies were entailed to inform the public, the government and FBI were notified, and various professionals were recruited to help quell the situation (Berge). Many measures were taken to guarantee both the protection of consumers and their products.

Johnson & Johnson’s reaction to the cyanide poisoning of their products was so successful due to the open and honest approach that they took. All of their decisions involved educating and reassuring the public, and in a way, this shifted blame from their company to the perpetrator- it painted them as victims of the situation, rather than the cause of the accident. What ultimately reestablished Johnson & Johnson’s approval and trust were their operations during the aftermath of the crisis. They released several campaigns that stressed consumer loyalty as well as their new safely-sealed container: they added a glued box, a plastic sear over the neck of the bottle, and a foil seal over the mouth of the bottle. Their decisions served as a prototype for all other companies, and later new packaging guidelines were established by the FDA.

In response to fears of Tylenol being poisoned, the company developed a triple-sealed package to protect against this threat.

While many viewpoints exist on the topic, Johnson & Johnson’s response to the Tylenol crisis is considered by many to be an admirable example of effective crisis management; several management strategies have even been constructed using this case as a guideline (Coombs). In fact, in the eyes of many scholars, this crisis was the single most exemplary case of crisis management. The most important aspect of Johnson & Johnson’s response to the crisis was their focus on the safety of the public. By withdrawing all products from the shelves and checking for additional contamination, Johnson & Johnson made it clear that they were invested in protecting their customers and preventing further incidents above all else, which was highly effective in re-establishing trust in the company (“Crisis Communication”). The decision to recall all products cost the company millions (“Crisis Communication”), but it was integral in communicating the company’s priorities and proving that they valued the public’s safety even more than their own profit. In addition to this, the company strengthened their credibility by maintaining open communication with the public throughout the aftermath of the crisis. They held several press conferences which were aired on live television, inviting the public to follow the company in its efforts to protect consumers from future events such as this (“Crisis Communication”). They also issued national alerts to ensure that everyone was aware of what had happened and would not use Tylenol until a solution had been reached (“The Tylenol Crisis”). To go even further, the head of the company at the time made appearances on shows such as 60 Minutes and the Donahue show to talk about the tragedy and share honestly about its impacts and how future complications could be prevented (Fink). Right from the start of the crisis, Johnson & Johnson acted very ethically by prioritizing the public’s safety and communicating openly and honestly, which made a world of difference in rebuilding trust in the company. They made sure that not only their words, but also their actions demonstrated remorse and consideration in the wake of the crisis.

Works Cited

Berge, T. (1990). The First 24-Hours. Cambridge, MA: Basil Blackwell, Inc. “Chicago Tylenol Murders.” Crime Museum, https://www.crimemuseum.org/crime-library/cold-cases/chicago-tylenol-murders/. Accessed 21 July 2022. Coombs, T. W. (1995). Choosing the right words: The development of guidelines for the selection of the “appropriate” crisis-response strategies. Management Communication Quarterly, 8 (4), 447-476. “Crisis Communication Strategies.” https://www.ou.edu/deptcomm/dodjcc/groups/02C2/Johnson%20&%20Johnson.htm. Accessed 18 July 2022. Fink, S. (1986). Crisis Management: Planning for the Inevitable. New York, NY: American Management Association. “The Tylenol Crisis could teach us about crises management”. advance-lexis-com.ezaccess.libraries.psu.edu/api/document?collection=news&id=urn:contentItem:5KKB-WNM1-F12G-D1M1-00000-00&context=1516831. Accessed July 18, 2022.

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Tylenol made a hero of Johnson & Johnson : The recall that started them all

By Judith Rehak, International Herald Tribune

• March 23, 2002

It has been almost two decades since a consumer products company's worst nightmare became tragic reality for Johnson & Johnson. In the space of a few days starting Sept. 29, 1982, seven people died in the Chicago area after taking cyanide-laced capsules of Extra-Strength Tylenol, the painkiller that was the drugmaker's best-selling product.

Marketers predicted that the Tylenol brand, which accounted for 17 percent of the company's net income in 1981, would never recover from the sabotage. But only two months later, Tylenol was headed back to the market, this time in tamper-proof packaging and bolstered by an extensive media campaign. A year later, its share of the $1.2 billion analgesic market, which had plunged to 7 percent from 37 percent following the poisoning, had climbed back to 30 percent.

What set apart Johnson & Johnson's handling of the crisis from others? It placed consumers first by recalling 31 million bottles of Tylenol capsules from store shelves and offering replacement product in the safer tablet form free of charge.

"Before 1982, nobody ever recalled anything," said Albert Tortorella, a managing director at Burson-Marsteller Inc., the New York public relations firm that advised Johnson & Johnson. "Companies often fiddle while Rome burns."

James Burke, the company's chairman, was widely admired for his leadership in the decision to pull Tylenol capsules off the market, and for his forthrightness in dealing with the media. In a news conference only a month and a half after the tragedy, he gave a full chronology of what the company had done. "He looked in complete control," said Tortorella.

The moves were costly. Johnson & Johnson spent more than $100 million for the 1982 recall and relaunch of Tylenol. A much smaller recall in 1986, and a second relaunch also ran into millions of dollars.

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