Let Them Eat Prozac: The Unhealthy Relationship between the Pharmaceutical Industry and Depression (review)

In his earlier books, David Healy established himself as an authority on the history of psychopharmacology. In this book, he covers much of the same interpretive ground, but in the form of a concrete and captivating story—his own experience in breaking ranks with the psychiatric establishment to draw attention to the hazards of Prozac and other selective serotonin reuptake inhibitors (SSRIs), culminating with his notorious dismissal from a prestigious professorship at a psychiatric unit at the University of Toronto heavily funded by Eli Lilly and Co., the makers of Prozac. As the title suggests, Healy finds in the history of psychopharmacology and his own experience the materials for a polemic challenging not simply the use of these drugs (indeed, he continues to favor their judicious use) but the entire scientific and regulatory framework of drug development. (In cooperation with the Canadian Association of University Teachers, Healy has made much of the material he uses to make his case—such as court transcripts, correspondence, industry memoranda, and government documents—available on a Web site, www.healyprozac.com.)

What is new to this book is Healy's personal perspective on the workings of the pharmaco-academic complex. In his earlier work, he developed in general terms the argument that in order to succeed, pharmaceutical companies needed to sell not only antidepressants, but the concept of depression as a widespread mental disease that these drugs would treat. Here he describes in amusing and appalling detail the mechanisms by which this was done—for example, the creation and influence of patient groups to advocate for a disease category; the communication and public relations agencies hired by the pharmaceutical companies to ghostwrite much of the "scientific" literature on psychotherapeutics; and the transformation of scientific meetings into trade fairs ("psychopharmacology means never having to go without a pen," he quips [p. 314 n 56]).

Healy argues that all this adds up to an imbalance of power radically favoring big pharma. He describes leading academic researchers who have lost control of their own research, "authoring" publications when they have never seen the raw data on which they are based; clinicians who are forced to prescribe for patients in the darkness of the highly selective data reported by the drug companies; and patients who are too fearful to stop taking the medications their doctors have put them on, even when they are experiencing traumatic side effects. Healy argues that fundamental changes in the regulatory structure are needed to redress this imbalance, such as creating a new regulatory body with the purpose of evaluating and managing hazards that emerge after a product is licensed, and/or making the raw data from all clinical trials available to the public.

This book seems to have arrived at a propitious moment. Many of Healy's views, which seemed extreme just a few years ago, are gaining credence in the psychiatric establishment. By the time the book was published, SSRIs had been persuasively linked to a heightened risk of suicide, and Lilly and other pharmaceutical companies were settling high-profile lawsuits in which Healy had been an expert witness. Since publication, a scandal erupted when it was discovered that the FDA had withheld data on the increased risk of suicide among youth on SSRIs (ironically, as of this writing, Prozac was the only SSRI the FDA regarded as safe for the treatment of youth), and the agency was preparing to issue new guidelines for use of the drugs in childhood and adolescence. In addition, pharmaceutical giants GlaxoSmithKline and Merck, under fire for hiding unfavorable trial results for the antidepressants and other drugs they market, pledged to make public the data for all clinical trials of all of their products. Whether or not Healy's views are ultimately vindicated in full, it seems clear that conditions are ripening for the pharmaco-academic complex he so devastatingly describes in...