The Tylenol Mafia (18 page)

On Monday, October 4
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, Larry Foster told reporters that Johnson & Johnson had “temporarily suspended production of ONLY Extra-Strength Tylenol [capsules], but all other Tylenol products are unaffected” (emphasis added).

J&J sent a “Dear Doctor” letter to doctors, hospitals, and warehouses on October 13
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, in which McNeil Medical Director, Thomas Gates, reminded customers: “There is widespread public confusion about which Tylenol products are involved. Many people do not understand that ONLY Extra-Strength Tylenol Capsules have been implicated” (emphasis added). This, however, was not entirely true.

J&J executives had learned on the very first day of the Tylenol murders investigation that a bottle of Regular Strength Tylenol - Lynn Reiner’s bottle – did contain cyanide-laced Tylenol capsules. Inside Reiner’s bottle of Regular Strength Tylenol capsules, were six Extra Strength Tylenol capsules; four contained cyanide. J&J executives could not have known that other bottles of Regular Strength Tylenol did not also contain cyanide-laced capsules – unless they knew that the tamperings had not actually occurred in the retail stores.

In October 1982, Chicago Police Lieutenant, August Locallo, said, “This case [the Tylenol murders] won’t be solved by deduction. Someone has to come forward and give us the key.” That key was in the evidence police had removed from Lynn Reiner’s home one day after the poisonings.

18

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Lynn Reiner had checked out of Central DuPage hospital on Tuesday, September 28, 1982, after giving birth to her son five days earlier. On the following afternoon, Lynn left her mother-in-law in charge of her 21-month old son, Jacob, and her newborn, Joshua, and made the short trip to Frank’s Finer Foods in Winfield, located right across the street from Central DuPage Hospital. Lynn bought one bottle of Regular Strength Tylenol capsules. She returned home shortly before 3:30 p.m. and then went through the bags she had brought home from the hospital - including the goodie-bag of product samples routinely given to moms at hospital maternity wards. That’s when she must have found the unit-dose package of Extra Strength Tylenol capsules she had been given at the hospital the previous day. Lynn opened the package of eight Extra Strength Tylenol capsules, swallowed two of them and then put the other six into her new bottle of Regular Strength Tylenol capsules.

Minutes later, Lynn’s husband, Ed, and their 8-year-old daughter, Michelle, returned home. They walked into the kitchen and entered what had suddenly become a chaotic and frightening scene. The emergency medical technicians from Leonard’s Ambulance Service and the Winfield Fire Department arrived at Reiner’s home at about 3:45 p.m. After working on Lynn at the house for several minutes, to no avail, the paramedics rushed her to Central DuPage Hospital. She was put on life support, but had already died minutes after swallowing the Tylenol capsule filled with the fast-acting cyanide.

Contrary to what officials have insinuated over the years, the cyanide-laced Extra Strength Tylenol capsule that killed Lynn Reiner had not been put into a bottle of Regular Strength Tylenol at the Frank’s Finer Foods store. It had instead come from a unit-dose package dispensed by a pharmacist at the closed-door pharmacy in Central DuPage Hospital. The hospital’s pharmacy was inaccessible to the public, and thus it was inaccessible to the Tylenol killer.

Moms like Lynn Reiner were routinely given Tylenol at hospital maternity wards. In fact, 90 percent of all non-prescription pain pills given to hospital patients in 1982 were Tylenol pills. So it makes perfect sense that before Lynn checked out of the hospital on Tuesday, she was given a unit-dose package of eight capsules - exactly one day’s worth of Extra Strength Tylenol at the recommended dose. Five of those capsules had been filled with cyanide before they were delivered to the hospital’s closed-door pharmacy.

In 1974, Central DuPage Hospital had converted its pharmacy to a unit-dose system. Drugs dispensed at unit-dose pharmacies are typically packaged at the hospital’s pharmacy in blister packs or plastic pouches in amounts that range from one dose to one day’s worth of doses.

The American Society of Hospital Pharmacists (AHSP) had published guidelines in 1980 for hospital-pharmacies. The guidelines said that for most medications, not more than a 24-hour supply of doses should be provided to outpatients at any one time (patients’ checking out of the hospital are considered outpatients). Reiner’s package of eight Extra Strength Tylenol capsules would have covered exactly 24 hours at the then recommended dose of two capsules every six hours.

The AHSP guidelines contained additional recommendations also relevant to the Reiner case:

Inpatient self-care and “discharge” medications are to be labeled as outpatient prescriptions. Outpatient medications are to be labeled in accordance with State Board of Pharmacy and federal regulations. Medications given to patients as “discharge medication” are to be labeled in the pharmacy (not by the nursing personnel) as outpatient prescriptions. The source of the medication and the initials of the dispenser are to be noted on the prescription form at the time of dispensing. If feasible, the lot number also is recorded. Nonprescription drugs are labeled like any other medication.

On Thursday morning, September 30
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, the Tylenol capsules in the pharmacy at Central DuPage Hospital were quarantined in accordance with AHSP guidelines, which stated that in the event of a recall, the hospital pharmacists were to quarantine all recalled products they obtained (marked “Quarantined—Do Not Use”) until they were picked up by or returned to the manufacturer. This is exactly what Central DuPage Hospital and every other hospital in the Chicago area did after the Tylenol poisonings. They quarantined the Tylenol capsules and waited for a Johnson & Johnson representative to pick them up.

Any cyanide-laced Tylenol capsules still in the pharmacy at Central DuPage Hospital on the day Johnson & Johnson learned about the murders were probably not there for long. By that afternoon, J&J had assigned Chicago area sales reps the job of checking to make sure local retailers and hospitals were not selling Extra Strength Tylenol capsules. One of those reps was likely dispatched to Central DuPage Hospital to confiscate all of their quarantined Tylenol capsules.

*****

About three weeks after Lynn’s death, James Burke hosted a pep rally for the company’s sales representatives. He played a testimonial style TV ad in which a woman professed her trust in Tylenol. “My first experience with Tylenol was in a hospital, after my son, Christopher, was born. Since then, it’s become one of the things we can count on,” said Paige Nagle, a San Diego homemaker who actually had first taken Tylenol in the hospital after the birth of her son. The narrator then announced, “Tylenol. You can trust our good name.” Just like the mom in this advertisement, which ran on network television in early 1983, Lynn Reiner’s recent experience with Tylenol had been in a hospital after her son was born.

Doctors were an integral part of Johnson & Johnson’s marketing strategy to restore Tylenol’s market share after the poisonings. J&J said in 1982 that 70 percent of all Tylenol users had at some time received a recommendation to use the drug from their physicians. What better advertisement could Johnson & Johnson have asked for than “unsolicited” recommendations from the doctors who gave Tylenol to their patients? Burke’s best salespeople were doctors.

The Washington Post
ran a story on July 7, 1987, summarizing a nationwide survey of nine hospitals by the editors of Consumer Reports. The only OTC analgesic stocked by eight of the nine hospitals surveyed was Tylenol. Hospitals used competitive bidding to buy drugs, so they usually stocked only one brand in each class of drugs. They preferred Tylenol said
Consumer Reports
because of the king-size discounts they received from Johnson & Johnson, which often underbid the competition, including the generic products. The reason Tylenol was “the pain reliever hospitals use most,” as the ads say, had little to do with quality, according to
Consumer Reports
. Rather, hospitals used Tylenol most because it was cheaper than other brands. Conversely,
Consumer Reports
found that for most individual consumers, Tylenol was one of the most expensive pain relievers when they later bought the drug at retail stores.

Since Tylenol owned a nearly monopolistic share of the nonprescription analgesic market in hospitals; doctors typically didn’t really have a choice of which OTC drug they gave to their hospital patients. This institutional marketing strategy served Johnson & Johnson well in November of 1982 when the company re-launched Tylenol in tamper-resistant packaging. Anyone harboring any fear about the safety of Tylenol probably overcame those fears when their very own doctor gave them Tylenol.

“People forget how we built up such a big and important franchise,” said Burke. “It was based on trust. People started taking Tylenol in hospitals or because their doctors recommended it. In other words, they were not well and in a highly emotional state,” said Burke. However, the “trust” that built the Tylenol franchise was the trust that patients had in their doctors.

*****

On the morning of September 30, 1982, just after the autopsy on Lynn Reiner’s body had begun at 9:45 a.m., the DuPage County Coroner’s Office received a call from Captain Enders of the Winfield Fire Department. Enders had been involved in the rescue call for Lynn the previous day. He told Deputy Coroner Peter Siekmann that Lynn had taken Tylenol shortly before she collapsed. Enders also advised Siekmann about the news reports of the Tylenol poisonings in Arlington Heights and Elk Grove Village.

As soon as he got off the phone with Enders, Siekmann called Winfield Police Chief, Carl Sostak, and asked him to go out to Reiner’s home to “retrieve any and all bottles of Tylenol or any Tylenol capsules which may not have been in any bottle.” Those are the exact words that Siekmann wrote in Reiner’s Coroner’s Report. Siekmann specifically asked Chief Sostak to check for any capsules that may not have been in any bottle. This statement implies that Siekmann had prior knowledge or at least a hunch that Reiner’s cyanide-laced capsules had been dispensed in a unit-dose package at the hospital, and thus would “not have been in any bottle.”

At around 11:00 a.m., Thursday morning, Winfield Police Officer Scott Watkins, accompanied by Chief Sostak, returned to the Reiner home to investigate what they now suspected was a murder. They sat down with Ed Reiner and gently questioned him about the events leading up to his wife’s death. They asked for details about her trip on Wednesday afternoon to Frank’s Finer Foods where she had purchased the bottle of Regular Strength Tylenol. They asked him if he knew anything about the Extra Strength Tylenol capsules that were inside Lynn’s Regular Strength Tylenol bottle. He did not. He guessed they were in the bottle when she bought them; probably put there at the manufacturing plant.

Sostak and Watkins then searched the Reiners’ home for Tylenol capsules, Tylenol bottles, and any other potential evidence. They found one bottle of Regular Strength Tylenol sitting on a shelf above the kitchen sink. Printed on the bottle’s label was the lot number, 1833MB. Police also found the box for the Regular Strength Tylenol bottle.

Chief Sostak brought Lynn’s Tylenol capsules to Peter Siekmann at the DuPage County Coroner’s Office in Wheaton. Siekmann turned them over to the Illinois Department of Health, also in Wheaton, shortly before 5 p.m. on Thursday afternoon. Toxicologists examined the capsules that evening, and completed their analysis just after midnight. Four of the remaining six Extra Strength Tylenol capsules in Reiner’s Regular Strength Tylenol bottle had been filled completely with cyanide. None of the Regular Strength Tylenol capsules contained cyanide.

On Friday, October 1
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, Siekmann told reporters that shortly before Lynn died, she had taken two Extra Strength Tylenol capsules, one of which contained cyanide, from a bottle containing other capsules laced with cyanide. He said the lot number for the Extra Strength capsules was not immediately known because Mrs. Reiner had carried them in a bottle of Regular Strength Tylenol capsules. However, investigators had in fact already tracked down the source of Reiner’s Extra Strength Tylenol capsules. Those capsules were from a unit-dose package, bearing lot number 1665LM, dispensed at Central DuPage Hospital. The existence of that lot number was revealed Friday night, but then quickly covered up.

At the request of officials from the Tylenol task force, NBC’s Chicago affiliate, WMAQ-TV, warned Chicago area residents that cyanide had been found in Extra Strength Tylenol from four different lots. In its 10 p.m. news broadcast of Friday, October 1
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, WMAQ-TV announced:

The task force is asking for help in solving the bizarre crime. They want those who still have Tylenol capsules from any of four lots to turn them over to their local police departments, or at least to the stores from which they were purchased. Those lots are labeled MC2880, MC2884, 1910MD, and 1665LM. Capsules are being tested around the clock for contamination and could provide valuable new leads in the case.

Prior to this WMAQ-TV news broadcast, officials had only disclosed the existence of cyanide-laced Extra Strength Tylenol capsules from Lots MC2880 and 1910MD. Nevertheless, officials had also found cyanide in Extra Strength Tylenol capsules from Lots MC2884 and 1665LM, but no national news outlet ever reported on the cyanide-laced Tylenol from these lots.