Prozac: Bitter Pill for David Healy: Academia Under Pharma Influence

Bitter pill
David Healy's open criticism of Prozac took him to a US court - and brought the relationship between academic institutions and the pharmaceutical companies centre stage

Sarah Boseley
Tuesday May 21, 2002
The Guardian

It took nearly 17 months, and the intervention of a batch of Nobel prizewinners, but at last a major international bust-up over academic freedom and the deep pockets of the pharmaceutical companies, fought out between psychiatrist David Healy and the University of Toronto, has been settled, out of court. The dust, however, will take longer to disperse.

Dr Healy is director of the North Wales department of psychological medicine, Bangor, which is part of the University of Wales College of Medicine. He is well known both as one of the foremost historians of psychopharmacology and as an outspoken critic of the Prozac class of antidepressants. Toronto may have sought him on the first count, but it was certainly well aware of the second when it offered him a psychiatry professorship in August 2000. By the end of the year, however, with only the immigration paperwork to complete, the job offer had been withdrawn abruptly. Quite why, and how, is a story with Le Carré reverberations.

The accusation at the heart of the affair was that the drug companies, and certain influential figures in psychiatry who receive large consultancy fees from them, scuppered Dr Healy's prospects in Toronto. The Centre for Addiction and Mental Health (CAMH) - where Dr Healy would have held a clinical role as director of the mood and anxiety programme, in addition to his academic post - has received more than $1.5m in recent years from Eli Lilly, the manufacturers of Prozac.

Lilly and other manufacturers of SSRIs (selective serotonin reuptake inhibitors) - as the Prozac class of drugs is known - have crossed swords with Dr Healy in the US courts. Dr Healy has been an expert witness against them, backing the claims of families who say the drugs have caused people to kill and commit suicide. In June 2001, just six months after his Toronto job was rescinded, a US jury agreed with him that Paxil (Seroxat in the UK), an SSRI manufactured by the British giant GlaxoSmithKline, caused Donald Schell to kill his wife, daughter, granddaughter and himself and awarded the remaining family members £4.2m compensation.

The Canadian Association of University Teachers (CAUT) backed Dr Healy with a passion when his job loss became public. For them, there was a troubling resonance with the case of Nancy Olivieri, the Toronto-based researcher who incurred the wrath of a pharmaceutical company when she told the world of the results of a clinical trial which showed, she believed, that a drug for thalassaemia would harm, rather than help, sick children. The Hospital for Sick Children, where she worked, part of the University of Toronto, tried to fire her when she refused to cooperate with an investigating committee whose members, she said, had too many links to drug companies.

With the backing of CAUT, Dr Healy began a legal action against the university. The case became high profile and a long list of respected scientists from all over the world, including Nobel prizewinners, signed a petition in defence of academic freedom. On April 29 a settlement was announced which was described as "a complete vindication for Dr Healy" by Vic Catano, president of CAUT. The University stated that "it underscores its support for free expression of critical views and acknowledges Dr Healy's scholarship by confirming it will be appointing him as a visiting professor in the faculty of medicine."

For his part, Dr Healy accepted that there had been no direct contact between the university and any of the drug companies before his job was rescinded. He never thought there had been, he says. The problem is deeper-rooted. The influence of the pharmaceutical industry within psychiatry is all-pervasive, he says, and in the case of some senior academics it is hard to see where their interests and those of the companies diverge.

It all went wrong for Dr Healy on November 30 2000, when he gave a lecture at CAMH. It was very well received by much of the audience both there and then a few days later at Cornell in New York. But David Goldbloom, physician-in-chief at CAMH, who was to be Dr Healy's new boss, was upset. People would take two things from the lecture, he told Dr Healy: first that Prozac caused people to commit suicide and second that antidepressants were too widely used. Within days he had emailed Dr Healy saying he had something urgent to discuss, and on December 7 he told him the job offer was rescinded on the grounds that there was "not a good fit" between him and CAMH.

The lecture was clearly key. Dr Goldbloom claimed many of those who would have been colleagues of Dr Healy's at CAMH were unhappy with it. But Dr Healy finds that surprising. "Almost any lecture I gave could have caused the problem," he said. More to the point, he believes, was the presence of Charles Nemeroff, a professor of psychopharmacology at Emory University in Atlanta at CAMH for the two-day meeting, has strong links to, and at the time held shares in, Eli Lilly, GlaxoSmithKline and Pfizer.

Professor Nemeroff, headlined "Boss of bosses" in the psychiatric journal Ten, which asked "Is the brash and controversial Charles Nemeroff the most powerful man in psychiatry?" and described him as "among the most coveted advisers to the pharmaceutical industry", was asked by the university for his opinion of Dr Healy's science, said his lawyer, Nina Gussack. The professor, said Ms Gussack,"finds himself to be at the very opposite end of the spectrum" from Healy on the issue of Prozac and suicide.

Discussion and debate is the very stuff academia. But Dr Healy found that his views were not being challenged in the lecture theatre or the seminar room - they were being undermined in private conversations. Somebody rang senior figures at Cornell, where he was due to speak just after Toronto, suggesting that he was manic depressive and even violent. But the lecture went ahead.

After the job offer was rescinded, another academic suddenly entered the fray against Dr Healy, but this time publicly. James Coyne, professor of psychology in the department of psychiatry at the University of Pennsylvania, says he first became involved because the Toronto Globe and Mail asked him for an opinion of a study of healthy volunteers that Dr Healy carried out in North Wales in which two out of 20 became suicidal on SSRIs. He expressed his firm opinion to the newspaper, and later to the British Medical Journal, that it was unethical because the volunteers were from Dr Healy's own hospital. The result, he told the Guardian, anyway "strains credibility" and had been blown up out of proportion. He told the BMJ that "as a paid expert witness, Dr Healy had a financial interest in the outcome of this 'study'" that should have been declared.

Professor Coyne told the Globe and Mail that he did not have drug company funding for his research. His name, however, is on the Eli Lilly website as a member of a committee handing out awards "to recognise excellence and courage in the mental health community". He is also a member of the Depression Knowledge Center Advisory Board, which describes itself as an independent institution, but is funded by Solvay Pharmaceuticals, which manufactures an SSRI.

The professor says he was paid $1,000 by Chamberlain Communications to judge an Eli Lilly-funded award. It was Chamberlain that organised prominent scientists to write reviews of the book Prozac Backlash, lambasting it for its criticisms of Lilly's best-selling drug, which were then sent to newspapers. Professor Coyne says he was also paid $400 indirectly by Solvay for an article criticising over-reliance on antidepressants at the end of life. "I leave for you to decide for yourself if these interests motivate my critiques of Healy. If these payments are the source for my critiques, I obviously come cheap," he told the Guardian.

Dr Healy says that, to his anger, Professor Coyne's criticisms of him in the BMJ were later passed to a journalist from Health Which in the UK by the Royal College of Psychiatrists, without an opportunity for him to refute them. He claims that the findings from his study have since been supported by a great deal more evidence that he has obtained through the court hearings and in company archives. He has passed much of his evidence to the Medicines Control Agency, which regulates the drugs.

The Healy case has shown up the blurring of the boundaries between academic institutions, which are short of money, and an industry that has a bottomless wallet - certainly in an area like psychiatry, where drugs have become hugely important. There is an urgent need for more openness, but the stakes have become very high.

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