Alex Gorsky, Chairman and CEO
Dominic J. Caruso, Exec. VP and CFO
Jennifer Taubert, Company Group Chairman, Johnson & Johnson
Ashley McEvoy, Exec. VP, Worldwide Chairman, Medical Devices
Sandra E. Peterson, Exec. VP, Group Worldwide Chairman
Kathryn E. Wengel, Exec. VP, Chief Global Supply Chain Officer
Paulus Stoffels, Exec. VP, Chief Scientific Officer
Michael H. Ullmann, Exec. VP, General Counsel
Ronald A. Kapusta, Corporate Controller, Chief Accounting Officer
NO. OF EMPLOYEES: 134,000
GLOBAL HEADQUARTERS: New Brunswick, N.J.
“The future is there...looking back at us. Trying to make sense of the fiction we will have become.
— William Gibson, “Pattern Recognition”
Some companies chase the future. Others shape it.
Apple clearly falls into the latter category. From its first computers—the rudimentary but revolutionary pre-assembled Apple 1 and graphical user interface-touting Lisa (the one that introduced the “mouse”)—to the pocket-sized iPod, touch computing iPhone, and netbook-killing iPad, Apple truly has changed the way humans socialize and communicate.
Google and Tesla are top morrow moulders as well. The former entity essentially cataloged the Web, giving structure to the jumbled mess of digital data that once littered the information superhighway. Its algorithms and index updates over the last 20 years have turned the tech giant into the go-to source of information (and quite a popular transitive verb). Tesla, on the other hand, is transforming the auto industry with its electric cars and autonomous (self-driving) vehicles, while also becoming a poster child for sustainability (its Powerwall rechargeable home battery system is guaranteed to store 70 percent of its rated power output at 10 years).
Johnson & Johnson considers itself a future forger too. Actually, the company’s chief executive claims the multinational conglomerate has dedicated its life to defining healthcare’s future. “Through the decades, Johnson & Johnson has advanced with the evolution of science and technology...” Chairman and CEO Alex Gorsky reminded shareholders at the start of the firm’s 2017 annual report. “In fact, every year for the past 132 years, Johnson & Johnson has been involved in defining the future of healthcare.”
Maybe not every year, admittedly. But certainly more often than not, J&J has been at the forefront of significant medical breakthroughs: It introduced the world to sterile surgical dressings and sutures (1887); first aid kits (1888); affordable dental floss (1898); BAND-AID adhesive bandages (1921); synthetic sterile sutures (1969); a disposable skin stapler (1978); coated sutures (1979); extended-wear disposable contact lenses (1987); minimally invasive gall bladder removal (1988); low-temperature gas plasma sterilization (1992); and a topical skin adhesive glue (1998).
ANALYST INSIGHTS: Since taking over the Medical Devices Businesses at J&J, Sandi Peterson has had an immediate impact on the J&J portfolio—leading to decisions to exit both its multi-billion dollar Sterilization and Diabetes businesses. With Sandi’s announced retirement later in 2018, watch for J&J to be efficient in bolt-on acquisitions for its core franchises (Ethicon, DePuy, etc.) while waiting to see how its investment in Verb Surgical (robotics) begins to take shape.
—Dave Sheppard, Co-Founder and Principal, MedWorld Advisors
The company picked up the pace of innovation with the millennium’s arrival, developing a coated antibacterial suture (2003); silicone gel implants (2006); a tissue expander with suturing tabs (2008); and a single-handed balloon sinuplasty device (2012), among others. Over the last few years, however, J&J has somewhat shifted its focus to better target (and shape) both digital healthcare and value-based medicine. In 2015, for example, the company teamed up with IBM’s Watson Health unit to create consumer-focused virtual coaching apps for knee replacement patients. Using Watson’s cognitive computing, the app predicts outcomes, suggests treatment plans, and provides personalized encouragement to patients during recovery.
Through its Ethicon subsidiary, J&J also has partnered with Alphabet Inc.’s Verily Life Sciences to develop a new robotic-assisted surgical solutions platform for improved access to minimally invasive surgery, greater hospital efficiency, and enhanced patient outcomes. Since the pairing, the partners have developed a surgical platform prototype encompassing robotics, visualization, advanced instrumentation, data analytics, and connectivity—an innovation the duo is calling “Surgery 4.0.”
J&J’s value-based healthcare initiatives aim to ease the transition to alternative reimbursement models and reinforce patient engagement, preventative care, and operational efficiency. Its Health and Wellness Technology Accelerator—a venture created in conjunction with Sunnyvale, Calif.-based Plug and Play Tech Center—specifically targets technologies that address nutrition, physical activity, stress, and sleep, as well as alcohol addiction and smoking cessation.
Likewise, the company’s CareAdvantage program is a holistic, data-driven approach designed to help companies shift to payment models tied to quality and/or value. The initiative uses data-driven analysis and insights, on-site assessments, and focused action plans to improve operational efficiency in cardiovascular medicine, surgical oncology, obesity, and orthopedics based on goal-specific targeted metrics. The orthopedic component combines a cloud-based platform for patient interaction, episode data analysis, infection risk reduction best practices, pre- and post-operative care (setting) expectations, and a standardized hip fracture care program.
“...we are convinced that technology will not replace but rather will extend human caring...Ahead we see a future that lies beyond the intersection of science and technology,” Gorski wrote in his shareholder letter. “We are rocketing toward that future, toward the very edge of imagination and possibility. That’s exciting, of course, and just a little daunting at the same time. Getting to that future will require urgency, boldness, and vision—characteristics most often attributed to very successful startups. However, I believe it is also a great description of this company today—a 132-year-old startup.”
Not many “startups,” however, are as fiscally fruitful as J&J. Last year, the New Brunswick, N.J.-based company increased its total revenue 6.3 percent to $76.4 billion and grew its per-share stock price by $24.51, or 21.3 percent (ending 2017 at $139.72). Gains occurred in each of J&J’s three product franchises, with Pharmaceutical posting the largest rise (8.3 percent) followed by Medical Devices (5.9 percent) and Consumer (2.2 percent).
The sales surge in Medical Devices is a redemption of sorts, for past franchise sins. Declining revenue in recent years prompted the company to implement a massive restructuring in 2016 and replace its slower-growing businesses with more profitable technologies—a strategy that surely induced the $1.045 billion sale of DePuy Synthes’ Codman Neurosurgery business last February and the $4.33 billion purchase of Abbott Medical Optics in September 2016. The swap-out scheme also was responsible for a handful of smaller bolt-on acquisitions last year that augmented J&J’s surgical solutions portfolio and expanded its capabilities in acid reflux treatment, expandable spinal cage technology, 3D printing, bone defect remedies, and hemorrhagic and ischemic stroke care.
Before changing ownership, J&J’s Codman Neurosurgery business made two key acquisitions: Pulsar Vascular Inc. of Los Gatos, Calif., (December 2016) and Neuravi Ltd. of Galway, Ireland, (April 2017). The Pulsar deal added a brain aneurysm treatment device to J&J’s stroke care lineup; the PulseRider product is a minimally invasive, self-expanding nitinol implant used to bridge the neck of cerebral aneurysms during treatment of unruptured wide-neck intracranial aneurysms originating on or near a bifurcation. The device’s “saddle” shape stent leaves minimal metal in the parent artery, enabling easy access to the aneurysm for coiling while maintaining support. Neuravi’s CE-Marked EmboTrap, on the other hand, captures blood clots and opens up blocked vessels.
J&J eventually rolled the two assets into a new neurosurgery business called Cerenovus (Latin for “new” and “brain”). The unit also houses Codman’s existing neurological product portfolio.
“We’ve been divesting slower-growth areas or areas that we think are better off in someone else’s hands and investing in higher growth areas and new technologies,” executive vice president and chief financial officer Dominic J. Caruso told investors during an April 2017 first-quarter conference call. “This particular ischemic stroke treatment from Neuravi is already on the market in Europe...it provides for faster blood flow and more accurate retrieval of the clot within the neurovascular system. Our entire medical device business has largely been grown by these smaller, tuck-in, bolt-on acquisitions with technologies that advance the standard of care and with our scale in distribution, we’re able to do much better with that asset in our hands than in the hands of the previous owner.”
ANALYST INSIGHTS: JNJ closed on the sale of its Diabetes unit (Lifescan Inc.) that included Animas and Calibra Medical for $2.1 billion less than what was rumored a year ago. Most experts believed this was a fair price for the $1.5 billion revenue-generating business unit that was declining and facing continued pricing pressure. It appears that JNJ will continue to focus on specialty pharmaceuticals, Baby Boomer-focused medical devices (hips, knees, spine, etc.) to capitalize on the aging of America, and acquisitions in the above areas focusing on pharmaceuticals.
—Mark Bonifacio, Founder and President, Bonifacio Consulting Services
Sentio LLC, Megadyne Medical Products Inc., and Torax Medical Inc. agreed with Caruso’s assessment. The first is now part of DePuy Synthes, while the latter two are within Ethicon Inc.
Last June’s Sentio purchase adds nerve localization technology to DePuy’s offerings, enabling the business to strengthen its spine portfolio in both decompression and lateral surgery procedures, and build a platform for future innovation in minimally invasive (MI) surgery.
Ethicon is planning to build a similar platform with the help of Draper, Utah-based Megadyne Medical and St. Paul, Minn.-headquartered Torax Medical. The former company specialized in “start-to-finish” electrosurgical equipment and accessories—products that are part of a fast-growing segment of MI surgical tools. Market data show demand for these products is being driven by pressure to increase efficiency and reduce healthcare spending as well as provide alternative procedures for aging patients who cannot undergo traditional surgery.
Likewise, the February 2017 purchase of Torax Medical adds a MI treatment for gastroesophageal reflux disease (the Linx Reflux Management System) to J&J’s product lineup and gives patients a less invasive option to laparoscopic Nissen fundoplication, which involves wrapping the upper part of the stomach around the esophagus and stitching it in place.
“All of the actions we’ve taken invest in the platforms we believe have significant growth. We’ve been doing this both in terms of acquisitions, strategic partnerships, and investing in R&D,” Sandra E. Peterson, J&J executive vice president and group worldwide chairman, said during a third-quarter earnings conference call last fall. “We’ve made a significant bet in our neurovascular business, where stroke is a huge unmet need and it’s only growing. We now have a business, due to some things we did internally as well as a couple of acquisitions in the last 12 months. You should see us, over time, build that business the way we have built the EP business.”
Cerenovus’ construction blueprint will likely closely match the project scheme for J&J’s new Vision franchise, which was formed last winter with the completion of the $4.32 billion Abbott Medical Optics deal. The business, part of the overall Medical Devices franchise, consists of two platforms—Johnson & Johnson Surgical Vision Inc. (formally Abbott Medical Optics, consisting of ophthalmic products in both cataract and laser refractive surgery); and Johnson & Johnson Vision Care Inc., maker of Acuvue brand contact lenses.
Each platform received inaugural “welcome” packages via acquisition, with Research Triangle Park, N.C.-based TearScience rolled into the Surgical Vision segment and Sightbox Inc. folded into the Vision Care division. TearScience produces devices that treat meibomian gland dysfunction, a leading underlying cause of dry eye disease, while Sightbox offers an online membership-based subscription service for U.S. contact lens wearers.
“2017 was a year of transition in our Medical Devices business. We’ve taken a lot of action regarding innovation, we’ve taken a lot of action pruning our portfolio, and we’ve taken action as well to improve execution in the field,” Gorski said in a January 2018 earnings call. “What we are pleased about is the fact that we saw an increase in the number of [product] launches, and improved execution. Given some of the reorganizations that have occurred, we think this is what helped produce some of the improvement in results.”
Seemingly negligible forces like a 5.7 percent operational increase and 0.2 percent positive currency impact didn’t hurt, either, though solid gains from most all Medical Device divisions largely contributed to the $26.6 billion franchise’s overall sales growth. The Vision segment boasted the largest increase, lifting sales 46 percent over 2016 to $4.06 billion on the backs of Abbott Medical Optics-related sales and new contact lens product launches. The latest market entrants helped drive a 9 percent rise in contact lens sales (to $3.04 billion) in 2017, whereas Abbott’s former wares gave Vision Surgical a premiere $1.02 billion bonanza.
Cardiovascular’s 13.4 percent rise in revenue (to $2.09 billion) came primarily from robust eletrophysiology market growth and continued uptake of the division’s THERMOCOOL SMARTTOUCH Contact Force Sensing Catheter, a U.S. Food and Drug Administration-approved device released in August 2016 that pairs contact force technology with a porous tip for optimum efficiency.
Surgery sales climbed 2.8 percent to $9.56 billion despite a 5.4 percent drop in Specialty Surgery proceeds (to $1.34 billion) due to lower demand for aesthetic, advanced sterilization, and Sterilmed Inc. reprocessed devices. Advanced and General Surgery counteracted the loss with 6.8 percent and 2.3 percent revenue increases ($3.76 billion and $4.46 billion, respectively), according to J&J’s 2017 annual report. The addition of Megadyne Medical’s lineup helped fuel growth in Advanced Surgery, as did strong sales of endocutter, biosurgery, and energy products like the ENSEAL X1 Large Jaw Tissue Sealer released last March. Designed for use in open general, gynecologic, urologic, thoracic, and vascular procedures, the ENSEAL X1 is an advanced bipolar device that provides better hemostasis and tissue management, and improved ergonomics.
Similarly, Torax Medical’s lineup bolstered General Surgery proceeds, but the division also benefited from strong demand for suture products, including the STRATAFIX brand of barbed sutures (introduced in conjunction with DePuy Synthes in March 2017) and the PROXISURE Suturing Device (released last August).
The STRATAFIX Knotless Tissue Control Devices feature barbs spaced 1 mm apart spiraling along a length of string that change direction midway down the suture; the design gives surgeons more control and flexibility while maintaining the necessary strength to hold tissues together without using knots.
PROXISURE is an advanced laparoscopic suturing device with wrist-like maneuverability and a curved needle for improved stitching precision in close spaces. The curved needle passes 180 degrees with each trigger pull, and is capable of suturing into flat or contoured surfaces. It can be used in MI surgeries for placing interrupted or running stitches in soft tissue.
“With the patient’s health at the forefront of our thinking, we aimed to introduce a suturing device that will help reduce the margin of error in minimally invasive surgery,” Ethicon Franchise Medical Director Dr. Niels-Derrek Schmitz noted upon the PROXISURE’s release.
Improved outcomes were foremost in thought within Orthopaedics as well: Sentio’s nerve localization platform, which locates nerves via adhesive skin sensors, can be set up by O.R. personnel rather than a neuromonitoring specialist. And, both the VIPER PRIME System and single-use CONCORDE Clear MIS Discectomy Tool aim to simplify minimally invasive spinal fusion surgery. The VIPER System combines multiple instruments into one pedicle screw inserter tool that reduces the number of instrument passes. CONCORDE, on the other hand, allows surgeons to complete the degenerated disc-clearing process faster on average and more efficiently compared to traditional discectomy tools while increasing the amount of disc material removed.
Such innovations, however, failed to move the needle forward in Orthopaedics last year. Division sales slipped 0.8 percent to $9.26 billion, as flatlining knee proceeds ($1.52 billion) and declining spine revenue (down 4 percent from 2016 to $3.72 billion) offset a 2.4 percent jump in hip sales ($1.39 billion) and 1.8 percent rise in trauma proceeds ($2.61 billion). J&J blamed the loss in spine revenue to pricing, competitive pressures, and the Codman Neurosurgery divestiture.
J&J’s departure from the North American insulin pump market had a similar effect on its Diabetes Care segment, reducing sales 9.7 percent to $1.61 billion. The company revealed its decision in early October and cited several reasons for the sudden withdrawal: changing customer needs, market dynamics, price declines, and increased competition (the last two also negatively impacted overall Diabetes franchise revenue).
J&J claimed the combination of challenges made it “too difficult to sustain the insulin pump business” (Animas Corp.) in the United States and Canada. The move does not affect Vibe and OneTouch Ping insulin pump sales outside North America. J&J referred nearly 90,000 U.S. and Canadian Animas pump users to Medtronic plc for supplies but noted that provisions will only be available from the rival firm through Sept. 30, 2019.
“We are committed to having all of our businesses deliver the highest levels of innovation, customer satisfaction, and overall performance,” Gorski said in J&J’s 2017 annual report. “Considering the progress we’ve made in our Medical Devices business, we are pleased, but never satisfied. We know there is still a great deal of work ahead of us to ensure we are ideally positioned to consistently deliver innovative solutions and value in 2018 and beyond.”