The best way to read Let Them Eat Prozac is to first consider
the events surrounding Healy's writing of the book. He reports to us that he wrote this book and The Creation of Psychopharmacology (2002) during 2000 (2004,
286). The year 2000 turns out to be a
pivotal year in Healy's career because of two separate scrapes with what
becomes the focus of Let Them Eat Prozac:
conflicts of interest between the pharmaceutical industry and academia.
The David Healy Affair
First, in late November 2000, Healy
travels to the University of Toronto's Department of Psychiatry who invites him
to speak for its seventy-fifth anniversary meeting, entitled "Looking
Back: Looking Ahead." A year before this trip, The Center for Addiction
and Mental Health (CAMH) has hired Healy as a professor of psychiatry in the
Mood and Anxiety Disorders Program.
Healy has not yet made the move to Canada because he was waiting on his
visa. Healy delivers a talk entitled:
"Psychopharmacology and the Government," which is basically an
outline of The Creation of
Psychopharmacology along with the assertion that SSRIs could make people
suicidal. This last point is, as I will
explain below, the occasion for which Healy pens Let Them Eat Prozac. The
chief physician at CAMH, David Goldbloom, hears Healy's talk and reacts quite
strongly to the content, particularly--to his mind--the irresponsible and
unscientific suggestion that SSRI drugs can lead to suicidality in
patients. Shortly after an
uncomfortable exchange with Goldbloom, Healy learns via email from Goldbloom
that CAMH has decided to withdraw the offer to of a position as Clinical
Director of the Mood and Anxiety Disorders program. Healy describes, briefly, these events in chapter 9, "The
Plot Thickens" (215-219), however, website dedicated to exposing these
makes public the email exchanges between Goldbloom and Healy, Healy's talk, and
subsequent letters written between various players in the scandal that
I strongly recommend reading
through these documents before delving into Let
Them Eat Prozac (even though Healy wrote most of the book before this took
place). Reading these documents brought
to life, more powerfully than the events narrated in the book, the dangerous
position that folks like Healy may be in regarding academic freedom now that
mega pharmaceutical corporations, like Eli Lilly and Co., fund department
research at places such as the CAMH at the University of Toronto. At the time Healy delivers his talk, the
Mood Disorders Program receives over 50 percent of its funding from
pharmaceutical companies (2004, 215).
While the reasons why Goldbloom rescinds his offer to Healy may never be
fully known, Healy points out that fear of losing precious and necessary
funding from Eli Lilly and Co. for research may, in fact, be a contributing
The second threat to Healy's
academic freedom follows an article that Healy publishes, entitled "Good
Science or Good Business?", in the March/April issue of The Hasting Center Report, which is a
bioethics journal. In this issue, Healy
Possibly, Prozac's success has also
depended partly on a lack of information . . .Current methods to estimate the
side effects of drugs in clinical trials actually underestimate them . . .the
SSRIs have been sold on the back of a claim that the rate of suicide is 600 per
every 100,000 patient years. But this
is the rate for people with severe depression, for which Prozac does not
work. The rate for primary care
depression is on the order of 30 out of every 100,000 people. Yet in these populations, suicide rates of
189 for every 100,000 on Prozac have been reported. Thus there are good
grounds to believe that Prozac can trigger suicidality. The pharmaceutical companies are not
investigating, however; one wonders whether they are receiving legal advice
echoing that given to the tobacco companies, that any investigation of these
issues may increase product liability" (2000, 21, my emphasis).
Soon after publication of this article, Eli Lilly and Co.
withdraws what constituted a substantial donor gift to the Hastings Center,
citing Healy's "unscientific" claim above as the reason. Hence, the writing of Let Them Eat Prozac is mired in disquieting examples of exactly
what Healy warns is discrediting the science of psychopharmacology: the need for
Big Pharma to make profits for its shareholders is more pressing that the need
for good science.
Good Science or Good
Them Eat Prozac is Healy's careful and, at times, tedious account of the
discovery of SSRIs and the events that lead to the unprecedented marketing and
prescribing of these drugs. Healy is a
first class scholar, supplying the reader with all available facts, figures and
names of major players in this episode of psychopharmacology. To an outsider to the field, keeping track
of all the major names and dates in this history can be challenging. Healy assiduously cites every possible
scientific and factual claim he makes in the book, which requires a great deal
of flipping back and forth to the comprehensive footnotes and bibliography. However, when I realized the stakes in the
writing of this book, reflecting on the Hastings Center, CAMH scandals and the
three trials against Big Pharma that Healy chronicles, it became a lot clearer
why Healy takes such pains to tell this story as completely and rigorously as
Healy begins the book by giving a
brief overview of the major changes occurring in psychiatry at the time that
Prozac is first discovered. What is
notable in these chapters is Healy's claim that the downfall of Valium and
other benzodiazepines in popular culture--due to claims that it was
addictive--coincide with a growing awareness that severe depression and bipolar
disorder is largely undetected and untreated.
Moreover, the conceptual framework of psychiatry shifts away from the
language of neuroses and anxiety, towards biological psychiatric paradigms that
conceive of mental disorders in terms of neurochemistry. The vacuum created by the public dismissal
of Valium then becomes filled by SSRIs, such as Prozac. Rather than treat "nerves" or
anxiety disorders, psychiatrists shift their attention to depression and its
biological mechanism (which the public wrongly assumes is low serotonin levels
). Pharmaceutical companies
quickly see a new market opening up for SSRIs, in part because the drugs
purportedly are more tolerable and patients could not overdose on these
drugs. The further you get into Let Them Eat Prozac, however, the sooner
you will be disabused of the belief that SSRIs are relatively safe.
The current pervasiveness and
popularity of the Prozac (and its SSRI cousins) for treating depression is
particularly remarkable because early clinical trials suggest that it is not
effective in treating severe depression, but rather for treating milder or subclinical
depressions (something to which Peter Kramer's book Listening to Prozac is a testament) (32). What also emerge early on in the clinical
trials of Prozac and in clinical practice is a concern that it causes akathisia (agitated states) (14-15). Shortly
after Prozac is released, in 1990, Martin Teicher, Carol Gold and Jonathan Cole
publish an article in the American
Journal of Psychiatry that suggests Prozac induces suicidality in patients
(42-45). Eli Lilly quickly moves to
discredit this study because it is conducted in a center that specialize in
suicidal patients, thus beginning the now familiar retort to the claim that
Prozac induces suicidality: it's the
disease, not the drug (see 59).
Healy dedicates the rest of the
book to cast doubt on this simple retort.
He details three court cases against Big Pharma: Fentress et al. vs. Eli
Lilly, Forsyth v. Eli Lilly, Tobin v. SmithKline Beecham. Each of these cases involves a suicide
and/or homicide allegedly brought on by Prozac, or Zoloft in the Tobin
case. Eli Lilly wins the first two
cases, but SmithKline Beecham loses the third case. Healy is an expert witness in the Forsyth case and latter the
Tobin case, which incidentally is pending during the whole "affair"
at the University of Toronto. Healy
inform how the lawyers for SmithKline Beecham could use this
"scandal" to discredit Healy's testimony, thereby weakening Tobin's
case. The details of these cases are
quite interesting as well as profoundly sad.
Healy reports on these cases to illustrate how messy and dangerous the
overlapping of Big Pharma, academics, physicians, and the FDA are:
One of the many chilling things
about the Prozac story is that a mistake or conspiracy would probably have cost
fewer lives. Instead, a sequence of
historical events made a poor drug fashionable, made the treatment of an
illness all but a matter of public policy, and removed the natural cautions and
safeguards that should have saved us.
In the midst of this, the one group with a professional brief, because of
prescription-only arrangements, to save us from ourselves--physicians--appears
to have followed its self-interest as much, if not more, than any other party
to the story(251).
A rather interesting revelation in
this book is that the Church of Scientology unwittingly contributes to lack of
studies and information on how SSRIs may induce suicidality. Scientologists are
a virulent strain of the "anti-psychiatrists." Their entire mission
is to bring down psychiatry and strategically focus their campaign by protesting
antidepressants and ADHD drugs (for an example, review the many news stories
about Tom Cruise's campaign against antidepressants). A 1990 Time article
reports that Scientologists rely heavily on lawsuits to bring down
psychiatrists and the pharmaceutical industries (59). This ticks off psychiatrists who then unite behind Big Pharma.
Relaying a conversation he has with an attorney involved in suits against Big
Pharma, Healy writes: " . . . I launched into the influence of the
Scientologists on the whole Prozac controversy. If they hadn't intervened, U.S. psychiatry wouldn't have stood
behind Lilly the way it had" (138).
Another troubling practice that
Healy exposes is how deeply Big Pharma has penetrated academic journals and
conferences. Apparently, Big Pharma hires writing agencies, such as Current
Medical Directions (CMD) to write up:
studies, review articles,
abstracts, journal supplements, product monographs, expert commentaries, and
textbook chapters. It conducts
meta-analyses and organizes journal supplements, satellite symposia, consensus
conferences, and even advisory boards for its clients. In the course of 1998, CMD, on behalf of
Pfizer, coordinated the authorship of approximately eighty-seven articles on
Zoloft. Of these, fifty-five were
published by early 2001. They targeted
the leading journals in the field, including the New England Journal of Medicine (NEJM), JAMA, Archives of General Psychiatry, and The American Journal of Psychiatry, in addition to journals well
known for the placement of psychopharmacology articles (116-117).
For Healy, the real concern that "ghostwritten"
articles pose is that the academics who allow their name to be put on the
article often never see the original data from which conclusions were made;
their judgment of the data is therefore skewed by what the pharmaceutical
company chooses to report. Big Pharma
owns all data of from clinical trials and RCTs, hence scientists cannot easily
get their hands on it to make independent judgments about the studies.
Healy reports his own experience
with being approached to present at symposia wholly underwritten and organized
by a pharmaceutical company as well as putting his name on a ghostwritten
article (112-116). The fact that Healy
reveals his own participation in these practices is interesting, since it opens
him up to charges of hypocrisy or complicity with the very market forces that
he thinks are threatening academic freedom and good scientific research in
psychopharmacology. To me, these
admissions reveal Healy's humanity.
Rather than resembling a "Socrates," whose pure dedication to
morality seems far from our all-too-human natures, Healy shows us how easy it
is to get involved with Big Pharma, to have them corrupt your own work, and the
ugly side to all of this as well: how
publicly disagreeing or discrediting them can put your livelihood and
reputation at stake.
Them Eat Prozac is a bold book and likely to draw a lot of criticism from
fellow psychopharmacologists. Moreover,
the problems and questions that Healy raise seem far from any easy solutions,
hence likely to make many readers--who might need psychopharmacological
treatment--weary of trusting their physicians or the pharmaceutical
industry. While certainly Healy doesn't
wish to wholly discredit his profession and carefully points out how hard it is
to tell the good from the bad guys in this story, it is possible that the less
careful or subtle readers of his book will make conclusions about psychiatry
that will unfortunately resemble anti-psychiatrists or even
Scientologists. I hope, however, that
those who undertake this book take the time to appreciate the balance and care
that Healy takes to present this story.
Side note: A companion website to this Let Them Eat Prozac is located at http://www.healyprozac.com/.
Healy, David. 2000.
"Good Science or Good Business?" Hastings Center Report
Healy, David. 2002.
The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press.
2005 Jennifer Hansen
Jennifer Hansen is an Associate Professor of
Philosophy at Gettysburg College. Her
research focuses on feminist theory and the intersection of psychiatry and
philosophy, with particular interest in affective disorders, such as