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.
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.
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.