What was the effect of the cyanide poisoning on Johnson & Johnsons as company?

In September of 1982, a 12-year-old girl and six adults in and around Chicago died suddenly and mysteriously. Hundreds of investigators looked into the cases and discovered that all the victims had taken Tylenol laced with cyanide.

The Tylenol murders fundamentally changed the way we consume medication – among other things, leading to tamper-proof pill and bottle designs. And 35 years later, this murder mystery is still unsolved.

KERA has been digging into these murders for a couple of years now. Reporter Lauren Silverman and Seema Yasmin, a former "disease detective" with the U.S. Centers for Disease Control and Prevention, dissected one of this country's most vexing medical mysteries.

The result is a "KERA News Investigation: The Tylenol Murders.” The hourlong special looks into the questions that confounded a nation – and the ones that have never been answered.

Sniffing cyanide

During the frantic search for clues in the fall of 1982, a public health nurse named Helen Jensen wonders out loud if something was wrong with the Tylenol pills everyone had taken. Some people think she's crazy. But the medical examiner Dr. Edmund Donoghue wonders if this is possible — if there might be a poison-like cyanide inside the Tylenol. So he calls a forensic investigator who is on the scene and over the phone asks him to smell the bottles.

"The thing is we just happened to have somebody out there who was capable of smelling cyanide," Donoghue said. "Only about half of the population can smell cyanide, and it's a genetically inherited trait. Classically, it's described as smelling like the odor of bitter almonds but our investigator said ‘Yeah, he could smell cyanide in the Tylenol bottles.'"

Donoghue examined the bodies, looking to see if cyanide was in fact inside. He notices a few things.

Their skin is red. Also, they smell strange – like bitter almonds.

When Donoghue looks inside their stomachs, he sees the lining is all eroded, and it's not acidic inside the stomach anymore, which is strange.

He puts all of these signs together: red skin, an almond smell, the eroded and alkaline stomachs and comes up with a theory.

To him, it looks like cyanide poisoning.

Changing how we take medicine

After the deaths in Chicago, Johnson & Johnson did something that turned the drug industry on its head and affects the way we take pills today: They changed the packaging and the actual pills.

It sounds like a trivial change, but the switch from capsules to caplets affected other drug companies, too. After Johnson & Johnson upgraded the packaging and adopted caplets, the whole industry rebooted.

Dr. Howard Markel, a University of Michigan professor, specializes in the history of medicine.

"I can't think of a single scary event that affected so much change in the physical presentation and the change and packaging of a medication other than the Tylenol scare," he said.

This led to a change in the law. In 1983, the Federal Anti-Tampering Bill was introduced that made it a felony to tamper with medicines. Some people still call it the "Tylenol bill."

The same bill made it an FDA requirement for medicines to be packaged with tamper-resistant technology — things like blister packs, shrink wrap bottle covers and visible seals.

CREDIT JOHNSON & JOHNSON

A dramatic turnaround

After the Tylenol deaths, many predicted the product would tank.

Johnson & Johnson confounded the marketing experts. One analyst called it "the greatest comeback since Lazarus."

Markel, the medical historian, calls it the biggest turnaround.

"The Tylenol story did change how most large corporations handle the recall issue," Markel said. "When they found something was wrong, it was no longer acceptable to turn your head the other way."

Johnson & Johnson ran such a skillful PR campaign that it's become the standard case study that business school students read for crisis management.

“I can’t think of a single scary event that affected so much change in the physical presentation and the change and packaging of a medication other than the Tylenol scare.”

Johnson & Johnson saved Tylenol in part by portraying itself as a victim — a victim of an attack from a dangerous "kook," as some investigators put it.

The company, the police, the government and the media started spreading the message that this was done by a madman.

This is the message that was repeated every day for months — and years after. And like any message repeated over and over, it stuck.

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

By Jennifer Latson

September 29, 2014 7:00 AM EDT

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.

What was the effect of the cyanide poisoning on Tylenol as a brand on Johnson & Johnson's as company?

When the tragedy happened what is the responsibility of Johnson & Johnson to the victim?

How did Johnson and Johnson recover from the Tylenol crisis?

What changes were done by Johnson & Johnson to its Tylenol brand to prevent the same incident to happen?