[Paleopsych] NYT: A Self-Effacing Scholar Is Psychiatry's Gadfly

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A Self-Effacing Scholar Is Psychiatry's Gadfly
http://www.nytimes.com/2005/11/15/science/15prof.html

    Scientist at Work | David Healy
    By BENEDICT CAREY

    His mother in Ireland is entirely unaware of his international
    reputation, as far as he can tell. His neighbors in the hamlet of
    Porthaethwy, on an island off the coast of Wales, are equally
    oblivious, or indifferent. His wife, who knows too well the furor he
    has caused, says simply, "How could you be right and everyone else
    wrong?"

    Dr. David Healy, a psychiatrist at the University of Cardiff and a
    vocal critic of his profession's overselling of psychiatric drugs, has
    achieved a rare kind of scientific celebrity: he is internationally
    known as both a scholar and a pariah.

    In 1997 he established himself as a leading historian of modern
    psychiatry with the book "The Antidepressant Era." Around the same
    time, he became more prominent for insisting in news media interviews
    and scientific papers that antidepressants could increase the risk of
    suicide, an unpopular position among his psychiatric colleagues, most
    of whom denied any link. By 2004, British and American drug
    regulators, responding in part to Dr. Healy and other critics, issued
    strong warnings that the drugs could cause suicidal thinking and
    behavior in some children and adolescents.

    But Dr. Healy went still further, accusing academic psychiatry of
    being complicit, wittingly or not, with the pharmaceutical industry in
    portraying many drugs as more effective and safer than the data
    showed.

    He regularly gets invitations to lecture around the world. But
    virtually none of his colleagues publicly take his side, at least not
    in North America.

    "It's strange. I don't even know about friends, what they think about
    me," Dr. Healy said in New York, as he waited for a flight after
    giving a lecture at Columbia. "You don't really know who you can
    trust."

    Because of his controversial views, Dr. Healy has lost at least one
    job opportunity, at the University of Toronto in 2001. In some
    circles, his name has become so radioactive that it shuts down
    discussion altogether.

    "People have called it the Healy effect," said Dr. Jane Garland, chief
    of the Mood and Anxiety Disorders Clinic at British Columbia
    Children's Hospital in Vancouver, who shares some of Dr. Healy's
    concerns about drug risks. "If you even raise the same issues he does,
    you're classified as being with David Healy and that makes people very
    reluctant to talk. He has become very isolated."

    Some colleagues have called him reckless, a false martyr whose
    grandstanding in the news media has driven away patients who need
    help. But they cannot dismiss him entirely. And for those who wish to
    understand what it takes to defy a scientific fraternity without
    entirely losing one's standing - or nerve - he has become a case
    study.

    Self-effacing on the surface, so soft-spoken he is sometimes barely
    audible, Dr. Healy, 51, seems far too agreeable to be a rabble-rouser.
    He acknowledges that antidepressants often work well, and he
    prescribes them in his own practice. He has consulted with drug
    makers, considers himself a part of the psychiatric establishment, and
    says that at least initially, he had no interest in shaking up the
    status quo.

    But when challenged, his voice quickens and his tone hardens.

    "He has this humility, maybe it's a family thing, but intellectually,
    I think he enjoys a duel," said Vera Sharav, a patient advocate who is
    president of the Alliance for Human Research Protection and a close
    ally. "And he has been stabbed in the back so often he just won't back
    down."

    In a pretrial hearing several years ago, for a suit against Pfizer,
    maker of the antidepressant Zoloft, Dr. John Davis, a psychiatrist at
    the University of Illinois at Chicago, took issue with Dr. Healy's
    testimony.

    "The lawyers on both sides were very skillful, very smart," Dr. Davis
    said, "but in the middle of my presentation - it wasn't a court trial,
    but a hearing - Dr. Healy got so incensed he got up, edged the
    plaintiff's lawyer out of the way and cross-examined me himself." Dr.
    Healy, he said, "couldn't sit there and let someone else do it; he
    wanted to come for me directly." But Dr. Davis, who does not himself
    accept drug company money, said he still respected Dr. Healy as a
    researcher.

    Betrayals - small and large - seem to fuel Dr. Healy's sense of
    mission. In New York several years ago, while poring through Pfizer
    documents, he found a handwritten note that described a conversation
    between a drug company employee and an old friend and colleague. Its
    subject was "the Healy problem."

    Dr. Healy froze, he recalled. He had gone to school with this
    psychiatrist, had known him for 20 years. When he called his friend to
    ask about the note, he said, the other psychiatrist shrugged it off.

    Through freedom of information requests and other methods, Dr. Healy
    has hoarded a variety of e-mail messages and other correspondence on
    "the Healy problem." He hands out copies at talks as evidence of a
    whisper campaign that he said started in the late 1990's, after he
    testified on behalf of plaintiffs suing Eli Lilly, maker of Prozac.

    "After that I was no longer invited to speak at professional
    association events, and I started seeing these things written about
    me," he said.

    Snubs followed slights. The job offer at Toronto's prestigious Center
    for Addiction and Mental Health, which came with a substantial pay
    increase, fell through. A raise he believes he was due years ago from
    Britain's National Health Service was delayed, he said. And there were
    accusations that his legal consulting fees, which he says have been
    about $40,000 a year since 1997, were affecting his scientific
    judgment.

    "Fees for an expert witness cannot be made contingent on the outcome
    of a case, but Healy is a repeat player in these legal actions, and
    future opportunities depend on past performance and a credible,
    predictable testimony," Dr. James Coyne of the University of
    Pennsylvania wrote in a recent article in The American Journal of
    Bioethics: "Lessons in Conflict of Interest: The Construction of the
    Martyrdom of David Healy and the Dilemma of Bioethics."

    Dr. Healy bristles at this criticism and says that his views, which he
    aired in scientific papers before consulting with lawyers, have cost
    him more in lost salary than he has earned as an expert witness. In
    about 9 of 10 cases he evaluated, he said, he concluded that the drug
    did not contribute to violent behavior.

    Yet such verbal assaults, some from former colleagues and others from
    drug companies and leading psychiatrists, have worked to fuse the man
    and his mission so that the two are now hard to separate.

    "He takes these things personally, and I would too," said Edward
    Shorter, a medical historian at the University of Toronto who is
    working with Dr. Healy on a book. "But it's not a matter of ego: he is
    offended because he believes that the field is not listening to the
    science."

    David Healy grew up with two sisters in Raheny, a suburb of Dublin,
    where his father worked as a civil servant in the health department
    and his mother ran the household. It was the 1950's, and Raheny was
    then a solidly middle-class community north of Dublin, on the working
    man's side of the tracks.

    After determining that he would probably not become a professional
    athlete, the boy became a committed student, strongly drawn to
    science, as his father had been. He graduated with high honors in
    medicine from University College in Dublin, and later worked in
    Galway, on the west coast of Ireland, conducting basic research on
    serotonin, a brain chemical linked to mood.

    Dr. Healy later joined the psychiatry department at Cambridge
    University in England as a research associate before moving to Wales,
    where he is now a psychiatrist in the North Wales department of
    psychological medicine and a professor at the University of Cardiff.

    He soon became familiar with isolation. He sat at his desk in the dead
    quiet from 8 p.m. to midnight, on an island off an island, and wrote
    without tiring: over the last 15 years he has published more than 100
    scientific papers and more than a dozen books on the history of
    psychiatric drug development. "I work at night because there is
    absolutely nothing going on where I live," he said.

    It was the reaction of two of his patients to Prozac in the early
    1990's, Dr. Healy has written, that led him to question its safety. In
    1990, Harvard researchers had reported several cases of suicidal
    thinking in patients on the drugs. But an analysis by the Food and
    Drug Administration found no evidence of increased risk, and
    psychiatrists largely ignored advocates who insisted the risk was
    real.

    After completing his own analysis, Dr. Healy came to agree with the
    critics, and he wrote letters to British drug regulators urging them
    to review the data related to suicide. By 2003, the BBC had reported
    on his objections; GlaxoSmithKline, the maker of Paxil, had come
    forward with unpublished data showing an increase in irritability and
    suicidal thinking in some minors on the drug; and British regulators
    began investigating the entire class of drugs.

    Drug company researchers and some psychiatrists moved quickly to
    deflate what they saw as overblown concern over drugs that they said
    had helped avert suicide in many severely depressed people. In 2004,
    Pfizer wrote a 50-page letter to the F.D.A. challengingDr. Healy's
    analysis, including his extrapolation from a small number of uncertain
    cases.

    The American Psychiatric Association publicly took issue with the new
    warnings on suicide risk. And many psychiatrists said publicly that
    denouncing the drugs would drive away people who needed them.

    Dr. Healy held his ground. He had, his friends and colleagues say,
    absolute confidence that he knew the topic as well as anyone.

    He concedes that no one knows what effect the F.D.A. warning will
    have. But this uncertainty, he says, is all the more reason that
    medical journals, professional groups like the psychiatric
    association, and drug regulators should make raw data from clinical
    trials public. "It wouldn't take much to bring a change. People don't
    realize the power they have," Dr. Healy said.

    As for Dr. Healy himself, he says he will continue to write and
    practice, traveling to lecture several times a year. He will also
    continue to follow his own scientific instincts, regardless of whom he
    offends. A new book, written with Dr. Shorter, is likely to alienate
    psychiatry's critics by defending one of psychiatry's most
    controversial treatments, electroshock therapy.