[Paleopsych] NYT: A Self-Effacing Scholar Is Psychiatry's Gadfly
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Sun Nov 20 18:44:37 UTC 2005
A Self-Effacing Scholar Is Psychiatry's Gadfly
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
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
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
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
"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
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
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
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
"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
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
"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
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
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
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.
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