BITTER PILL

A British Academic Claims That Prozac, One Of The Bestselling Drugs Of All
Time, Can Drive People To Suicide, Even If They Aren't Depressed - Did His
Views Cost Him A Job In Canada?

David Healy was looking forward to moving to Canada. For the British
psycho-pharmacologist, author of the definitive history of anti-depressant
drugs, the invitation to take up a post at the University of Toronto made
absolute sense. Apart from the academic advantages, his claims that the
drug Prozac and its copycat sisters can make some people commit suicide
were taking him to the United States increasingly often to testify on
behalf of bereaved families against the drug companies.

It wasn't to happen. Healy's move across the Atlantic, closer to the field
of battle over some of the bestselling drugs of all time, has been
scuppered in what some see as the latest skirmish in a dirty war to stop
him and others from speaking out.

The stakes are huge. The pharmaceutical group Eli Lilly made $2.6bn from
Prozac last year alone and is pulling out all the stops to register the
drug for new uses now that its patent is at an end. It has just succeeded
in getting it renamed and repackaged as Sarafem, for severe premenstrual
tension, which will keep the profits rolling in until 2007.

If Healy is right, there is a risk that a minority of people on Prozac will
take their own lives. He calculates that a quarter of a million people
worldwide have tried to commit suicide because of Prozac, and that 25,000
have succeeded. For the manufacturers of the SSRIs (selective serotonin
re-uptake inhibitors, as this class of drug is called) Healy's work is
enormously damaging.

Eli Lilly claims that there is absolutely no evidence of a link between
Prozac and suicide, but in academic circles Healy, who is director of the
North Wales department of psychological medicine, has a high reputation.
Two years ago he began to be courted by the Centre for Addiction and Mental
Health (CAMH) at Toronto University. He spent three days there in July
1999. Afterwards Paul Garfinkel, the chair of the department, wrote an
appreciative letter, looking forward to the chance to "discuss more
specifically the arrangements for you in Toronto".

On January 28 last year Sidney Kennedy, another professor in the
department, wrote with full details of the position Healy was being
offered. Last August the formal offer was made by David Goldbloom,
physician in chief at CAMH. Healy formallyaccepted it in September.

Then in November Healy was invited to speak at a two-day conference at
CAMH. Everything seemed to be going smoothly. He was urged by Goldbloom to
give one month's notice instead of three months'. He was told: "We need to
get you here within weeks rather than months."

The talk on November 30 appeared to go down well. The same talk received
acclaim in the US a few days later and again earlier this year in Paris.
But in Toronto Goldbloom showed signs of distress. According to Healy,
Goldbloom was worried that the main thing people would take away from his
talk was the claim that Prozac can cause suicide.

Within a few days Healy received an email from Goldbloom, saying he had
something urgent to discuss. Goldbloom finally broke the news by email on
December 7. "Essentially, we believe that it is not a good fit between you
and the role as leader of an academic program in mood and anxiety disorders
at the centre and in relation to the university," he said. "This view was
solidified by your recent appearance at the centre in the context of an
academic lecture. While you are held in high regard as a scholar of the
history of modern psychiatry, we do not feel your approach is compatible
with the goals for development of the academic and clinical resource that
we have."

The decision to rescind the job offer, apparently within hours of a talk on
the dangers of Prozac, has caused uproar in Canadian academic circles
because CAMH has been funded by Eli Lilly to the tune of more than $1.5m in
recent years. To the Canadian Association of University Teachers, what has
happened to Healy is "an affront to academic freedom in Canada".

It has hit a nerve that is already raw. Last year an international furore
broke out over Nancy Olivieri, the Toronto-based scientist who broke a
confidentiality agreement with the pharmaceutical company Apotex and
published research concerning the level of toxicity of its drug Deferiprone
for children suffering from the hereditary blood disease thalassaemia. At
one point the Hospital for Sick Children, part of Toronto University, tried
to sack her. James Turk, executive director of the association, draws a
parallel with the treatment of Healy. "This is every bit as serious as the
Olivieri case - and that's a very serious one," he says. "We can't see how
this can be other than a serious erosion of academic freedom."

Turk says the wording of Goldbloom's email is telling. "Development is a
euphemism here for fundraising. I read that as meaning, 'Your appointment
will make it more difficult to raise the money that we need to pursue our
programmes.'"

The crucial question is what - or who - persuaded CAMH to change its mind.
Healy's views are well known. But what Goldbloom and his colleagues may not
have appreciated - until someone told them - was the significance of
employing an academic with such views in a world where research is heavily
reliant on drug-company grants. That someone, says Healy, may have been
Charles Nemeroff, a professor of psycho-pharmacology at Emory University in
Atlanta who has strong links, including shareholdings, to Eli Lilly,
GlaxoSmithKline and Pfizer, the three companies which make SSRIs that are,
or have been, involved in court cases in which Healy has been an expert
witness.

Nemeroff was at the Toronto meeting, but did not stay for the second day.
Instead he went to another gathering in New York, where, says Healy: "My
understanding is that he was saying I had lost my job." That was a week
before Healy knew it himself.

Nemeroff has made no secret of his hostility to Healy's work. In July last
year, at the British Association for Psychopharmacology, Healy says that
Nemeroff berated him over a study he had carried out of the effects of one
of the SSRIs on healthy volunteers. Two out of 20 became suicidal.

"He began, as far as I can remember, by stating that I had no right
publishing material like that," says Healy. "I mentioned that it was all
good, clear-cut science, and that there were other findings in the
literature which backed this up. He said it would be bad for my career to
get involved in all this - that in the course of the previous few weeks he
had been approached on five occasions to see whether he would testify in
legal actions against me."

Nemeroff's office refers press calls to Nina M Gussack, a Philadelphia
lawyer, who has defended Eli Lilly in Prozac litigation. She denies that he
orchestrated the loss of Healy's job, but she says that university
officials did ask his opinion of Healy's science.

The University of Toronto denies that the Prozac issue was connected with
the change of heart over Healy. Asked what "not a good fit" meant,
Garfinkel says: "It means that the search committee had in its internal
deliberations reasons to feel that there were going to be better
opportunities for our mood programme."

But Healy says the attitude to him of everybody at Toronto was very
positive until the talk, and he was even asked to sit on an interview panel
for a post that would be under his supervision when he moved to Canada.

Eli Lilly denies having exerted any influence. "Lilly was not involved in
any decision to withdraw the job offer to Dr Healy as Lilly does not get
involved in employment matters of its grant recipients," it says in a
statement. Any suggestion that what happened would have a bearing on future
court cases "would be purely speculation, and we don't comment on speculation".

However, Andy Vickery, of Vickery and Waldner, a law firm based in Houston,
Texas, which has retained Healy as an expert witness in several cases
concerning SSRIs, says he has no doubt that what happened to Healy was
connected with the litigation. Healy, he says, is a problem for those who
want to "perpetuate the myth that there's no problem with these drugs".