Author: Reyanna Paul

The Chicago Tylenol murders in 1982 were a cataclysmic crime that drove development of tamper-evident packaging. The series of deaths were caused by poisoning from potassium cyanide being laced in Tylenol-branded acetaminophen capsules. At least seven deaths resulted from this crime. While a suspect was never charged for the poisonings, a man named James Lewis was convicted of extortion for having sent a letter to Johnson & Johnson in which he took responsibility for the deaths and demanded $1 million from the company. Johnson & Johnson ultimately recovered from the scare and reintroduced Tylenol capsules in a triple-sealed package to prevent tampering, marking the beginning of many changes in how medications were packaged.

In 1983, Congress passed the Federal Anti-Tampering Act, also dubbed the “Tylenol Bill,” which made it a felony to tamper with consumer products. The FDA also updated their policy in 1989 to make medications more resistant to tampering, requiring tamper-evident seals on over-the-counter medications. This also led to the manufacturing of medication dosage forms transitioning from capsules to modern caplets. Some capsules can be opened to access the medication inside, whereas the same cannot be done for caplets because they have a film or gelatin coating that cannot easily be modified without leaving behind evidence of tampering.

The goal is not to make packaging completely “tamper-proof,” as considering that since the buyer must access the medication themself, this is nearly impossible. Instead, packaging design has evolved so that any interference with the container would be obvious to the buyer, discouraging them from buying or using the product. The triple-sealed package that Johnson & Johnson debuted after the Tylenol murders is one example. Most modern over-the-counter medications now reflect this triple-seal package, adopting a plastic shrink around the cap, a foil or paper seal glued to the bottle mouth and a breakaway cap. These simple but effective features have become a standard in modern pharmaceuticals by functioning as a safeguard for the integrity of the medication and the consumer’s health.

Laura Bix, Michigan State University, the impact of the tylenol murders on drug packaging in the Inspired to Heal episode Drug Packaging Protects Patients

In this two-part episode of Inspired to Heal, “Healthcare Behind Bars” & “Cook County Jail: Public Health, & Prevention” host Bill Trick speaks with Dr. Jack Raba, whose medical career found itself intertwined with Cook County’s correctional system at many points in his life. He volunteered during high school, where he sat with patients to hear their stories. While studying to be a priest, he worked with a family near the hospital and felt a calling to leave the seminary and go to medical school to heal people differently. After medical school, he chose to train at Cook County Hospital, where Dr. Raba observed suboptimal facilities for patient care. He became the president of the Cook County house staff doctors’ union and within two months, the union provided a list of demands for their contract; nearly all centered around improving conditions for patient care. After Dr. Raba and several other doctors went on strike, six of them—one of them being Dr. Raba—were sent to jail. After his release, Dr. Raba found himself on the other side of the bars as the medical director of Cook County Jail, where he implemented several important public health initiatives around control of communicable diseases, such as tuberculosis, and recognized and exposed police violence. 

Dr. Raba’s choice to put two items in his doctor’s bag: elimination of the cash bond and treatment, rather than incarceration, for substance use. He spoke of seeing inmates housed for long periods of time in Cook County Jail for nonviolent crimes who could not post cash bail and how this disproportionately punished poor people. Rather than incarcerate individuals for drug offenses, the money should be used towards behavioral health treatment for substance use disorders or mental health conditions; it costs roughly $45,000 per year to incarcerate an individual. Approximately 44% of jail inmates have a mental illness compared to 18% of the general U.S. population. Thus, the three largest mental health facilities in the U.S. are jails—Cook County Jail being one of these three. Dr. Raba’s life work in correctional healthcare demonstrates how one individual, leading a dedicated team of healthcare workers, can meaningfully impact the lives of many people. His compassion and humility shine through in this interview.

For the episode “Essential Items for your Medical Bag”, Inspired to Heal compiled a montage of guests’ responses to the question: “If you could choose one item to put into your medical bag, literal or figurative, what would it be?” Most responses were figurative—but what might the literal contents be? The items in a medical bag evolved over time. The now defunct mirror affixed to a doctor’s forehead, as mentioned in Peter Clarke’s response, is one of the most notable tools that speaks to this evolution. Before modern fiberoptic scopes, doctors relied on mirrors and rigid instruments to see inside the body. As a precursor to the doctor’s forehead mirror, in 1854—Manuel García, a Spanish singing teacher, used a dental mirror and sunlight reflected from a hand mirror to visualize his own vocal cords. His curiosity laid the foundation for the use of mirrors to visualize the throat, also known as laryngoscopy. Johann Czermak modified the process by using a light source concentrated by a concave mirror; thus, avoiding the wait for a sunny day. However, instruments that arose from this observation, like the laryngeal mirror and esophageal specula, required intense lighting and precise angles.

In 1957, Dr. Basil Hirschowitz refined fiberoptic technology and in the spirit of Manuel Garcia, visualized his own vocal cords, and subsequently, a patient’s throat was examined days later. The key innovation was the use of flexible glass fibers, which could transmit light through bends and curves, using the principle of total internal reflection. This principle describes how light travelling through a medium encounters a boundary with a less dense medium and is then reflected back into the original medium. In short, bundles of these fibers carry light into the patient’s body and return a visual image back to the physician’s eyepiece. Hirschowitz used coherent fiber bundles; each fiber stayed in the same relative position from one end to the other, allowing a clear image to form. He, along with physician Larry Curtiss, invented a flexible, steerable endoscope, leading to clearer and more comfortable visualization of the esophagus and stomach—something rigid scopes of the past failed to accomplish. These advances in fiberoptics improved comfort for patients and gave doctors a more detailed view of patients’ internal structures in real time, revolutionizing modern diagnostics and minimally invasive procedures.