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June 2001

Dark clouds over Toronto psychiatry research

Karen Birmingham

New York

The University of Toronto (UT) and its affiliated hospitals have become embroiled in another controversy regarding their attitude to corporate donors versus their behavior towards employees.

David Healy

British psychiatrist David Healy accepted a senior position at the Centre for Addiction and Mental Health (CAMH) and the Department of Psychiatry at UT only to have the offer withdrawn months later on the basis of a speech he made at the University. The speech was highly critical of the pharmaceutical industry.

Healy, the Director of the North Wales Department of Psychological Medicine at the University of Wales in the UK, is a prolific author and his views on neurological medicines are widely known. He has acted as a medical expert in several legal cases involving antidepressant drugs.

He says he was courted by CAMH faculty over a period of 18 months to join the group as Clinical Director of the Mood and Anxiety Disorders Program and as a Full Professor in the Department of Psychiatry at UT. He formally accepted the offer on 13 September, 2000 and proceeded to apply for an immigration visa for himself and his family.

On 30 November last year, Healy took part in a symposium at UT and presented a lecture that he subsequently repeated at Cornell University, New York, and at the Centre for National Research in Health in Paris. The talk also forms the synopsis of a forthcoming Harvard University Press book.

Despite an evaluation form showing that Healy's talk was rated highest for 'content that met the audience's needs and objectives'—above that of speakers such as Steven Hyman, director of the US National Institute of Mental Health—Healy's future bosses took offense to the speech. On 8 December, David Goldbloom, Physician-in-Chief at CAMH emailed Healy canceling his faculty appointment. Goldbloom wrote, "...we believe that it is not a good fit between you and the role as leader of an academic program...This view was solidified by your recent appearance at the Centre in the context of an academic lecture...."

The lecture was an historical account of psychiatric medicine and was highly focused on the role of the pharmaceutical industry. For example, Healy said the reason for the development of new antipsychotic drugs was to create medicines without the tardive dyskinesia side-effects of older drugs and not because these were better for the disease symptoms of schizophrenia. Regarding institutionalization, he said patients in Britain "are being detained at 3 times greater rate than 50 years ago."

He repeated his views on antidepressant drugs: "I happen to believe that Prozac and other SSRIs can lead to suicide. These drugs may have been responsible for 1 death for every day that Prozac has been on the market in North America." And he went on to question why no research has been carried out to determine whether the drug does or does not cause suicide.

Towards the end of the lecture, Healy said that the information from the human genome will give rise to products belonging "almost exclusively to pharmaceutical corporations. If they are advised in the way that they are at present, this knowledge, which is so democratically important, will operate against the interests of democracy."

The manufacturer of Prozac, Eli Lilly, is acknowledged on CAMH's website to be its largest sponsor, having donated over CAN$1 million (US$645,000). While no-one is suggesting that Lilly played any part in the decision to sack Healy, some are questioning whether CAMH faculty were sufficiently worried about offending donors that they sacrificed the recruitment.

Jim Turk

CAMH denies that the issue rests on Healy's statements about Prozac. Paul Garfinkel, chair of Psychiatry at UT, told Nature Medicine, "Our search committee knew of his views on Prozac, but that alone doesn't do it. It was the variety of extreme views [in his talk] based on extraordinary extrapolations and incompatibility with scientific evidence. ...his views...shocked a large number of future colleagues to the point where they felt he did not have the respect and support of the staff."

Specifically, Garfinkel cites Healy's comments about the rise in psychiatric hospitalization and his claim that "a significant proportion of the scientific literature is now ghost written [by people in the pharmaceutical industry]." Garfinkel says, "We have no idea where this comes from. Dr Healy has made sweeping statements that do not meet the standards of science."

The case has caught the attention of the Canadian Association of University Teachers (CAUT), an organization that represents 30,000 faculty across Canada. CAUT does not buy CAMH's explanation for canceling Healy's appointment—or see why such a lengthy and detailed hiring process can be reversed on one lecture—and is calling for an independent inquiry into the issue. "We are quite appalled at what appears to be a flagrant violation of academic freedom. Here's an institution—both CAMH and UT—that is uncomfortable having an outspoken critic of the pharmaceutical industry," says CAUT Executive Director, Jim Turk. "We will launch our own investigation if necessary, as we have had to do in the Olivieri case. That report is due out next month." (see overleaf).

Turk told Nature Medicine, "We think there's a very dark cloud over the University of Toronto and its affiliated teaching hospitals. We're sending out a message that this top notch university isn't prepared to tolerate dissent and diversity of viewpoints and amongst medical researchers."

The Faculty Association at UT has also filed a notice of Breech of Academic Freedom and will proceed to a formal grievance procedure if the University does not respond in 3 weeks. Meanwhile, Healy is considering whether to file a legal suit against CAMH for breech of contract.