[e-drug] Prozac (fluoxetine) story

[love@cptech.org]

E-drug: Prozac (fluoxetine) story
-------------------------------------------------------------------------

http://thestar.com/cgi-bin/gx.cgi/AppLogic+FTContentServer?GXHC_gx_sessi  
on_id_FutureTenseContentServer=3f0f71439eb01a6c&pagename=thestar/Layout/  
Article_Type1&c=Article&cid=990156883387&call_page=TS_News&call_pageid=9  
68332188492&call_pagepath=News/News

or search for Prozac on: http://Thestar.com

May 19, 2001. 01:01 AM

A tale of researchers, drug companies and job offers
Slinger, COLUMNIST

ACADEMIC MEDICINE refers to the kind of medicine practised in university
medical schools and in teaching hospitals such as the Toronto Hospital,
the Hospital for Sick Children, and the Centre for Addiction and Mental
Health, which includes the Clarke Institute Of Psychiatry and the Queen
St. Mental Health Centre. In a moment we will get to a quotation that
reads, 'the atrocious venality of modern academic medicine.'' They are
the words of Richard Horton, editor of The Lancet, a British medical
publication that is one of the most esteemed in the world.

A year ago, the Centre for Addiction and Mental Health contracted to
hire Dr. David Healy away from the University of Wales. A psychiatrist
with a specialty in the effects of drugs used to treat psychiatric
ailments, he was given a teaching job on the University of Toronto
faculty and a research position at CAMH. Seven months later - before he
could move here and start work - CAMH cancelled the contract; it fired
him.

He was fired one week after he visited CAMH and delivered a lecture
about research he had done that indicated possible dangers with the drug
Prozac, the best known and biggest selling of all anti-depressants.
Prozac is manufactured by Eli Lilly, the biggest contributor to the CAMH
capital development fund and to its research program.

Last week, six months after the Healy firing, The Economist carried an
ad placed by the Ontario government promoting the province's ``R&D'' -
research and development - ``environment.'' One full page is taken up
with a photograph of Gaetano Crupi, the president of Eli Lilly Canada.
The text on the facing page reads, ``Ontario merits close scrutiny, as
leading global pharmaceutical companies continue to discover. Among the
first was Eli Lilly, collaborating with University of Toronto
scientists, Banting and Best, on the commercial purification of
insulin.''

It continues, ``Now investing over 20 per cent of sales on R&D, Lilly's
current research continues at both the clinical and the molecular
level,'' and boasts that R&D tax credits make Ontario ``an excellent
locale'' for life sciences. ``Equally important is our critical mass of
scientific talent - working in internationally recognized research
universities, hospitals and private sector facilities.''

The timing is exquisite. The ad appears when one of those ``recognized
research universities'' - the U of T - and one of its teaching
hospitals, and their involvement with the drug company about which
Ontario is so darned proud, are causing researchers at every academic
medical institution in the country to feel icy fingers around the
research grants they have received from pharmaceutical companies and the
cheques they must depend on from these companies to continue their work.

After Healy's lecture at CAMH, Dr. David Goldbloom, the
physician-in-chief, informed him he no longer had the job. Wrote
Goldbloom, ``we do not feel your approach is compatible with the goals
for development of the academic and clinical resources that we have.''

If ``development'' in this context doesn't mean fundraising, and CAMH
insists it doesn't, it's almost the only time in the history of
university administration jargon that it hasn't. CAMH insists the
reasons for firing Healy had nothing to do with his comments about
Prozac, suggesting instead that his would-have-been colleagues found his
approach a shade lightweight.

Timing rears its ironic head in two other aspects of this story. One: It
happened while Eli Lilly itself is in a state of high anxiety. Last
August a U.S. court cut two years off Lilly's patent on Prozac. The next
day its shares swooned from $108.56 to $67.38, reducing its stock market
value by $46 billion (figures in U.S. dollars).

Here is CAMH's most generous donor about to have the heart of its profit
ripped out and nose-diving into the financial dumper. The company's
chairman, Sidney Taurel, said, ``Lilly will have to do what no pharmacy
company has done; weather the patent loss of its biggest product and
continue to grow.''

At the moment it is considered particularly vulnerable to a takeover
bid. In other words, Lilly is a wounded tiger. Provoking it would hardly
be appreciated.

Two: Healy had been saying the very same things about Prozac, based on
the very same data, long before CAMH offered him the job, but three
months after Lilly hit the crunch it was no longer ``compatible'' with
CAMH's goals.

His thinking was far from secret. Two months before CAMH made its
official offer (following a year in which it has been described as
``courting'' him), The Observer, one of the more distinguished British
Sunday newspapers, carried a story under the headline ``Spiral of
violence blamed on Prozac'' that referred to Healy's research and his
finding that a number of healthy people - that is, non-depressed; normal
if you like - given Prozac became mentally restless and lost all
inhibitions about their actions. Healy told The Observer, ``We can make
healthy volunteers belligerent, fearful, suicidal, and even pose a risk
to others.'' In his CAMH lecture he referred to the suicidal
inclinations of some of these test subjects and - again based on the
same data, and again widely publicized before he was offered the job -
speculated that Prozac and drugs like it might cause one suicide a day.

How could CAMH not have known all this when it hired him? It would be
like hiring Newton and then discovering he held an unsuspected theory
about the direction apples travel when they fall off the tree. The
rigorous examination of candidates for university faculty jobs,
particularly for jobs at teaching hospitals, is famous. Was CAMH asleep
- more like in a coma - at the switch? Was it so eager to get this guy
it didn't look too closely? If there were doubts about the quality of
his research, it is bizarre that these weren't mentioned in the nearly
two years between initial approach and firing. Maybe his views, which
were known to everybody else in the field, didn't seem particularly
important at the outset.

In The New York Review of Books, Richard Horton, the editor of The
Lancet, reviewed a frightening book about the rebirth of thalidomide as
a therapeutic drug.

Horton calls the relationship between many research MDs and
pharmaceutical companies ``close to corrupt.'' There is ``convincing
evidence that in some cases the opinions of medical experts can be
bought by the highest bidder. Doctors who take money from drug companies
are more likely to sing the company line - hiding anxieties about safety
- than those who keep their hands firmly in their pockets. Such is the
atrocious venality of modern academic medicine.''

As the cost of drug development soars and the competition among drug
companies gets even stiffer, ``The notion of pharmaceutical research as
a curiosity-driven enterprise in the service of medicine has become a
comforting but erroneous myth.''

Interest declared: Not long after CAMH was fully incorporated into the U
of T as a teaching hospital, my wife resigned as vice-chair of the
centre's board of directors because of differences with the chief
executive officer that had to do with patient care.

--------------------------------------------------------
James Love
Consumer Project on Technology
P.O. Box 19367, Washington, DC 20036
http://www.cptech.org
love@cptech.org
1.202.387.8030 fax 1.202.234.5176

--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Information and archive http://www.healthnet.org/programs/edrug.html
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-e-drug@usa.healthnet.org'.