Our Ref: DH/JT

15th February 2001

Herb Solway
Chair, Board of Trustees Ethics Committee
Centre for Addiction & Mental Health
33 Russell Street
Toronto Ontario

Dear Mr Solway

I am writing to you as chair of the ethics review board with an issue that I believe has significant ethical implications for the Centre and the university.

I was recruited to a post in the Centre for Addiction and Mental Health over a year ago. Following an invited talk at a CAMH and university of Toronto department of psychiatry anniversary meeting on November 30th 2000, the offer of a post was rescinded. I am certain that at least some members of the Centre and of the university of Toronto would appreciate knowing something more of the background to this story. Hence this letter.

The sequence of events chronologically is as follows. Shortly after I was offered a post in the department of psychiatry in Toronto, an article of mine appeared in the Hastings Center Reports issue of March 2000. This made reference to the capacity of Prozac to induce suicidality. This is a view I have expressed now in six peer-reviewed publications and in a number of other publications since 1991, as well as in numerous scientific meetings since 1991. None of these publications have led to any legal action by Lilly, the makers of Prozac. I have regularly offered to debate the issues in a public forum with anyone the company cares to put up to defend their position. I offered to present the material in CAMH before my appointment and during the course of the last year.

When the March issue of the Hastings Center Reports came out, in an unprecedented move, Lilly withdrew their funding from the Center, citing this specific issue as the reason for so doing.

Later in the summer of 2000, I presented data from a healthy volunteer study we had conducted at three scientific meetings in Europe. This study shed further light on the phenomenon of SSRI induced suicidality. At one of these meetings I was assaulted by Charles Nemeroff (- details enclosed as document 1).

The department of psychiatry in Toronto organised a meeting for November 29th and 30th, Looking Back, Looking Ahead, to celebrate the 75th anniversary of the department. Both Dr Nemeroff and I were scheduled to speak on the program.

Before the November meeting, I came over early to finalise details concerning my prospective move to Toronto. The day before the meeting I spent time with David Goldbloom, the physician in chief at the CAMH, talking about removal expenses among other things. I let him know of my involvement in SSRI and other medico-legal work. This appeared to pose no problems to Dr Goldbloom, whose only concern appeared to be whether I could give one month's notice in the UK rather than three months. He gave me his home phone number and email details so that my wife could check out schools for our children with his wife.

The day of the meeting, a number of members of the CAMH (Nov 30th) were at Lilly's HQ in Indianapolis to discuss academic "products" stemming from Lilly's support for the Toronto department of psychiatry. As far as I'm aware, this support, negotiated in the first instance by Franco Vaccarino, makes Lilly the department's biggest outside money source.

The talk I gave at the meeting is attached (document 2).

This talk began life as a talk for a major meeting in Europe for the pharmaceutical company, Astra-Zeneca. It was enthusiastically received and led to invitations to deliver the same talk again in other A-Z forums.

The talk is a synopsis of a forthcoming Harvard University Press book, which will come with a review on its back cover stating that it is the most important book on the history of psychiatry since Ellenberger's Discovery of the Unconscious.

I gave the same talk, a week later in Cornell University, on Dec 5th and 6th, as the guest speaker at the Eric T Carlsson Annual Memorial Grand Rounds and the Richardson Research Seminar in the History of Psychiatry. It is a talk I have since given in the Centre for National Research in Health in Paris.

After the talk in Cornell, Jack Barchas, the editor for the Archives of General Psychiatry, said to me that there was little work happening in Cornell, except for some of the work being done by Nobellists, such as Eric Kandel, that stood a chance of being remembered 100 years from now, but that my work would be remembered.

After the talk in Toronto, the feedback forms for the day rated my talk the highest in terms of content, with Dr Nemeroff's being voted the lowest (document 3).

The day of talk in Toronto, however, Sid Kennedy let me know that it had not gone down well with Drs Goldbloom and Vaccarino. Dr Kennedy mentioned specifically that Dr Goldbloom was troubled by claims that Prozac could precipitate suicide, that Lilly knew about this (a claim never made), and that the mental health services were admitting more patients than ever before. (I presented the figures underpinning this claim in a lecture in the CAMH in July 2000 and the data will be published shortly in a premier peer-reviewed journal).

On the evening of the 30th the CAMH had a gala meal. At this, I set up what I thought would be a simple conversation with Dr Goldbloom. He was too livid to engage in any constructive discussion. But he managed to say that people only ever remembered three things from a talk and that all they would remember from mine were claims that Prozac could cause suicide, that Lilly knew about this, and that high dose antipsychotics had caused brain damage.

The following week in New York, I checked my emails and found an email from Dr Goldbloom suggesting a conversation between Dr Kennedy, himself and myself. With my schedule it was a practical impossibility for me to talk to him by phone before Monday 11th. Dr Goldbloom indicated that he would continue the conversation by email.

What I did not know at this point was that on Friday (Dec 1st), Dr Nemeroff, who did not stay in Toronto on Thursday the 30th, told council members at a committee meeting in New York of the American Foundation for the Prevention of Suicide that Healy's job offer in Toronto was about to be rescinded. Some of those there were unhappy at both the event and his behaviour.

This suggests that the decision had been made on Thursday the 30th, that in some sense it involved Dr Nemeroff, that it did not involve any general discussion among senior Centre personnel, and that Dr Goldbloom was so emotional because he hadn't the courage to discuss the real situation with me rather than because of any concern for Lilly or patients.

On Dec 8th when I arrived home, I found an email from Dr Goldbloom telling me my job offer had been rescinded - see enclosed document 4.

Trying to get any details out of anyone in the university since has been impossible. Everyone says they can't talk about the issue with whoever approaches them about it, that if anyone wants to talk to Dr Goldbloom about his decision, they need to talk to him (document 5). Shades of Rangoon.

Possible Concerns
This letter arises from a number of concerns. The concerns relate in part to the fact that the events in Toronto are already in the public domain. Dr Nemeroff has taken care of that. A great number of New York psychiatrists knew about what had happened before I did. This public profile is likely to increase rather than decrease.

Based simply on the documents available to me, some of which are enclosed, the CAMH looks bad. This might have implications for Centre funding from Lilly, and possibly also from other SSRI companies if the public profile of the available documentary evidence were to prove a significant medico-legal problem for Lilly and other SSRI companies.

There is a dilemma in terms of managing the issues for the Centre, or anyone acting on its behalf and appearing to speak for Centre staff. Taking any public profile risks damaging the interests of one or other party in a number of ongoing high profile legal actions. This is something that the Centre presumably would not wish to do without knowing more about the science base to the issues. Or at least there may be many in the Centre and indeed in the wider university who may be distressed at a strong public position by the Centre that is at odds with the science base.

Any spokesperson on behalf of the university or the Centre may also wish to know that the events that have befallen me are not unique. My understanding is that there have been similar events involving some of the same players. The events surrounding last November now form something of a consistent pattern.

There are also implications for future recruitment to the Centre and perhaps to the medical school in general. The most benign interpretation of the events is that the Centre has idiosyncratic recruitment procedures, vulnerable to input from a loose canon from another university or institution.

But Dr Goldbloom's email also appears to contain the chilling message that I would have been summarily dismissed had I actually been in post. This would have left me with no other possibility to work in Canada. At a time when the university is seeking to attract outside talent, I would imagine this would deter anyone from the United Kingdom or Europe, where a development like this is inconceivable, anyone "bringing an important line of critical enquiry and clinical research acumen to this department" (letter Dr S Kennedy Jan 28th 2000), from taking up a post in Toronto.

The above serious consequences stem from a benign interpretation of the events. Some of the uncontestable facts, however, make it clear that a less benign interpretation is also possible and is one that many of the public may well think the more likely. The implications of such an interpretation stretch well beyond the confines of the university of Toronto.

You may agree with me that these events pose an ethical problem for the Centre and by extension for the medical school and the university. In this case, it may not be appropriate for me to have any further input, as I am neither a member of the Centre nor the university. If so, I will be interested to hear at some point in the future how the various issues were resolved.

Should you wish further input from me, I will be happy to liase with you or anyone else who picks the issues up. There is usually room for manoeuvre within the constraints of facts and documents. I am, as it turns out, due to give a lecture at a meeting in Toronto in the near future.

Yours sincerely,

Dr D Healy, MD FRCPsych

Director, North Wales Department of Psychological Medicine

Cc Pamela Fralick
Dr Paul Garfinkel
Dr David Naylor
Others in the University