The following post is by Dr. David Egilman, a familiar figure to those who have been following the case of Eli Lillyâs schizophrenia drug Zyprexa. See Alex Berensonâs New York Times articles on the case for more background, or read David Michaelsâs post about Zyprexa and sequestered science. -- Editor
âThe Truth is Not Freeâ
By David Egilman
September 11, 2007
All that is needed for the forces of evil to succeed is for enough good people to remain silent.
-- Edmund Burke
The consequences of silence can be devastating. My father spent WWII in a German concentration camp largely as a consequence of silence. In response to the Holocaust, which was facilitated by the silence of a nation, I have devoted much of my professional career to studying and reporting the effects of silence on public health.
Last December, I was subpoenaed for copies of internal documents that I acquired as a consulting witness in litigation against the pharmaceutical company Eli Lilly. I released all of the documents I had, which made their way to The New York Times and became the basis for four major articles. After the Times stories ran, 30 states subpoenaed documents detailing Lilly's sales, marketing and promotional practices for Zyprexa as part of civil investigations under state consumer protection laws.
I recently reached a settlement with Lilly and agreed to pay the company $100,000. I admitted responsibility for violating the protective order that kept Lilly's documents secret. I admitted that the documents I leaked did not tell the full story about Zyprexa. I did not, however, admit that Lilly's "story" of the drug is based on fact, nor did I admit to any illegal conduct. And notably, although Lilly claims that the stories that ran in the Times did not accurately reflect its marketing practices or its knowledge of Zyprexa's side effects, Lilly has refused to release documents that it claims paint a different picture. Even today, Lilly fights in court to keep those documents secret from the public.
However, I refuse to silence my voice on the dangerous effects of corporate secrecy. History has demonstrated time and time again that such silence brings nothing but harm.
The silence of asbestos companies and their doctors, who hid their knowledge of the hazards of asbestos, permitted a carcinogen to be used for a century in schools, homes and offices. The entire town of Libby, Montana fell victim to that silence. Too late, litigation revealed what companies and their doctors had known for over a hundred years. Asbestos was killing thousands.
The silence of flavoring companies and their doctors, who hid their knowledge of the hazards of butter flavored popcorn, allowed these toxic foods to be sold to an unsuspecting public for more than 20 years. The recent outbreak of lung disease in consumers of butter flavored popcorn is the cost of this silence. Yet litigation revealed the truth â these companies had known the flavorings caused disease for decades. In this case, there may still be time to avoid another asbestos-like epidemic.
The silence of Eli Lilly & Company and their doctors about the hazards of Oraflex, a drug they knew caused fatal liver failure, resulted in unnecessary deaths of American patients. Once again, litigation revealed the truth. Lilly pleaded guilty to 25 criminal charges of failing to inform the United States government about adverse reactions to Oraflex and mislabeling the drug.Â
The same story keeps repeating itself. Over the years, silica, lead, tobacco, pesticides, beryllium, Vioxx, Oraflex and hundreds of other toxic products have ended up in our food, our medicine, our air and our water. It is the silence of corporations and their doctors, not a lack of knowledge, which is the root cause of this never-ending circle of public health disasters.
This blanket of silence is becoming so heavy that doctors are forgetting where their loyalties lie. The medical director of one asbestos company was asked why he hadn't warned his patients, those who developed asbestosis and cancer from their work, of the hazards of asbestos. He explained that he had indeed warned his patients; that the company was his "patient." I refuse to go the way of that doctor and remain silent on issues important to the public health, for the cost is always the loss of innocent lives.
When I graduated from medical school, I took an oath to protect the public health. That oath supersedes all other agreements, including those that prevent me from protecting public health by releasing information. My obligation to the health and safety of others is the same as that of a physician who informs the police about a patient who has "in confidence" threatened injury on another. My obligation is the same as that of a pediatrician who "violates" confidentiality to report possible child abuse to the police.  Â
If Lilly has "secret" documents that indicate that its drugs are safe or that their marketing practices were appropriate, they have the right to release them and it is in their interest to do so. Their silence is deafening.Â
Silence can injure and kill. For public health, the sound of silence is the funeral dirge. I have not and will never play that tune.
All that is needed for the forces of evil to succeed is for enough good people to remain silent.
David S. Egilman, MD, MPH is Clinical Associate Professor at Brown Universityâs Department of Community Health.
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How come no one commented? The September 19 article already has a comment. Is everyone scared into silence? Or dead?
I applaud your honesty Dr. I wish there were more like you. My son was prescribed Zyprexa back when it was new. I refused because it had aspartame in it. Little did I know....
To this day I am dealing with a pretty wild 15 yo who I cannot even take to a Dr. because I cannot trust them. We just try to cope.
Dear Dr. Eglinman,
I took an atypical antipsychotic drug similar to Zyprexa when I had encephalitis. I was suffering from delirium because I was physically ill. I had never been committed or sent to a mental hospital prior to this. The drug almost killed me.
My heart was racing, my head pounded to the point that I felt as if it would explode, my ears were ringing because my blood pressure was so high...I nearly died. My weakened physical condition may have contributed to the effects of the drug or maybe everyone who takes it has this reaction the first time. I can certainly understand why so many refuse to "accept treatment" if their experience is anything like mine.
I knew I was sick but I didn't know I had encephalitis. I reported my severe adverse reaction to a primary care physician along with my cognitive difficulties. Instead of offering concern for my health, he was outraged that I suggested that the antipsychotic drug could have contributed to my condition. He then made my minimal and extremely limited mental health history public without my knowledge or consent, embellishing the story by claiming I was involuntarily committed. There's an implied malice to his actions. The local police immediately put me at the top of their list of suspects in every situation from a small fire to terrorism and stalking with no evidence to support my involvement in any crime. Hysteria insued in the small community were I lived.
Unlike you, most doctors hold pharmaceutical companies in high regard and anyone with even a one time misdiagnosis of mental illness in contempt. Pharmaceutical companies like Eli Lilly who manufacture drugs for the mentally ill have a built in defense for any claims of adverse or deadly reactions to their drugs: the person is mentally ill.
If the drug injures a mentally ill person, the patients are just imagining it. Any person labeled menatlly ill, whether the diagnosis has any clinical justification or not, has no credibility in this society. It took psychiatrists 30 years to acknowledge that antipsychotics caused Tardive Dyskinesia and Neuroleptic Malignant Syndrome. The objective evidence of these conditions was right in front of them for years, yet they denied it. Why? Because the people complaining about the effects of the drugs were mentally ill. No credibility.
Likewise, those labeled mentally ill have no worth as human beings. If they die as a result of taking a drug, it doesn't matter because they were less than fully human to begin with. They are damaged people with defective brains so their lives weren't worth living anyway. How else can one explain the fact that antipsychotics have killed many times more people than Vioxx did in the same period according to the FDA, yet not one antipsychotic has been pulled off the market by the FDA as Vioxx has.
Even animals have more protection from harmful drugs than the mentally ill do. The same antipsychotics used to sedate and disable animals in a veterinarian's office are used on the mentally ill. Guidelines that limit their use in animals to protect them from injury are followed but not so with the mentally ill. I met a formerly gifted college student who after being dosed with antipsychotics is so brain damaged that he can no longer communicate effectively with others or function independently. His grieving mother can't find a lawyer to represent him because what jury would financially punish a noble doctor for destroying the life of a worthless mentally ill person? Animals have more worth in our society than mental patients.
If you had revealed secret documents that proved that a drug for women with breast cancer or children with asthma or any other group of patients were dangerous, you would have been recognized as the hero you are for coming forward and breaking the silence. Instead you protected a group that is dehumanized, feared, hated, mocked and held in contempt in our society, the mentally ill. Thank God for doctors like you.
You're right. It isn't the lack of knowledge that allows these tragedies to continue. Employees at Eli Lilly knew for years how dangerous Zyprexa was and is. Not one of them came forward. It is the lack of moral courage to speak up and break the silence that creates and allows these atrocities.
Only when compassion and decency overcome cowardice and greed will this type of needless suffering and death end.
Sincerely,
Mary Ellen Gottlieb
Great post Dr. asbestos