Book: Let Them Eat Prozac
Authors: Joe Collier
Journal: BMJ (2004)

This is a curate's egg of a book. It addresses the wrongs associated with the overuse of fluoxetine (Prozac) in the treatment of patients with depression, choosing to do so at two different levels.​levels.




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David Healy

James Lorimer & Company Ltd, $C29.95, pp 462 ISBN 1 55028 783 4 www.lorimer.ca

Rating: ★★




As a populist tract (one has to assume that the book is directed primarily at a north American lay readership), the text is essentially autobiographical, overlong, over-indulgent, somewhat uncritical, and often indiscreet. Healy's aim seems to be one of self advancement as he tells of the buffeting and injustices that have befallen him while fighting to expose and reverse various wrongdoings. The saga, for that is what it is (it has already lasted nearly 20 years), is chronicled in detail, with accounts of Healy's run-ins with the courts, medical journals (including the BMJ), drug companies, professional colleagues, appointments committees, and regulators.

In passing, he praises some sections of the media and damns others; slips effortlessly from his working as a consultant to the industry to being one of its arch critics; and moves from emotive narrative to scientific evidence with confusing ease. The thread of the story is often difficult to follow, and is in a style that echoes the description “too long, too unfocused, and insufficiently clear,” used by BMJ editor Richard Smith when criticising a manuscript submitted by Healy for publication.

But the book is not all bad. Healy is an academic psychopharmacologist of some repute and one with enormous experience and proven scientific research credentials. Writing at an altogether more sophisticated level he develops a series of “scientific” arguments that expose something of a scam. Intertwined through the populist text there is a persuasive seam asserting that, in most people with depression, selective serotonin re-uptake inhibitors (SSRIs such as Prozac) offer little or no help; that SSRIs (for example, Prozac) give patients suicidal ideas and increase the risk of their committing (or attempting to commit) suicide; and that manufacturers marketed the early SSRIs (for example, Prozac) as antidepressants (rather than as anxiolytics) for political (rather than clinical/pharmacological) reasons. Moreover, Healy argues that Eli Lilly (the manufacturer of Prozac), together with others, worked to create a market for antidepressant drugs far in excess of actual clinical need, and that Eli Lilly (again among others), successfully used underhand ways to counter the real position.

The arguments supporting Healy's position are exhaustively referenced, using information published in clinical trials or given in lectures, coupled with personal communications and data appearing in the lay media. Added to these are data Healy has obtained as an adviser to the industry, which have surfaced as evidence in court or been revealed through the US freedom of information laws. Accordingly, much of the source material is not available in standard databases, and as such the set of references is a collector's item and comparable in richness to those of other leading health commentators such as John Abraham and Charles Medawar.

It would be easy for some to dismiss the book because of its populist elements. In my view, dismissal out of hand is not an option. The book contains serious allegations and ones that deserve to be addressed. Some form of investigation would be appropriate, and this should be independent of at least the industry and the regulators. To do otherwise would be an injustice.