Copyright 2000 Globe Newspaper Company
The Boston
Globe
July 12, 2000, Wednesday ,THIRD EDITION
SECTION: LIVING; Pg. C1
LENGTH: 697 words
HEADLINE:
ALEX BEAM;
LISTENING TO PROZAC AND THE BACKLASH
BYLINE: BY ALEX BEAM, GLOBE STAFF
BODY:
Last week, Eli Lilly & Co. announced that
it had received Food and Drug Administration approval to market
Prozac under a new name, Sarafem. It's the same antidepressant
drug, but now Lilly is encouraging doctors to prescribe it for
Pre-Menstrual Dysphoria Disorder (PMDD) a relatively new condition deemed to be
an extreme form of pre-menstrual syndrome.
Forget for a moment that some
doctors question whether PMDD actually exists. Forget for a moment that an
English academic has claimed that the poet Sylvia Plath killed herself because
of PMDD, which is probably bosh. That's not the point; the point is that Lilly
has achieved a cherished "brand extension," and will succeed in
selling more pills.
Prozac occupies the intersection
of two primal, American compulsions: the need to sell, and the lure of the quick
fix. That's what makes it so fascinating. Capitalizing on clever marketing,
brutal infighting, and tens of thousands of genuine success stories, Lilly has
made Prozac the symbol of Americans' innocent desire to feel better.
Twenty-eight million Americans, many of whom are wary of psychiatry and would
think twice before taking a pill stronger than Extra-Strength Tylenol, have been
willing to give Prozac a try.
Now Prozac is under siege. After a
euphoric high in the early 1990s, patients and researchers are stepping forward
to take their whacks at Prozac and its sister drugs Zoloft,
Paxil, etc. Authors Lauren Slater, Peter Breggin, and most recently Joseph
Glenmullen of the Harvard Medical School have all described the unpleasant
underside of the little green-and-cream-colored wonder pills: Prozac loses
effectiveness over time; the drug creates painful withdrawal
symptoms; it induces sexual dysfunction, and - the most dramatic charge of all -
it may exacerbate depressed patients' suicidal tendencies.
Lilly, which
sells over $2 billion worth of Prozac every year, doesn't take
criticism lightly. One of the most hair-raising stories in American
jurisprudence, retold in Glenmullen's new book "Prozac Backlash," was Lilly's
outrageous behavior in the so-called Wesbacker trial. Several years ago, a group
of plaintiffs sought to prove that Prozac prompted a (depressed and suicidal)
pressman named Joseph Wesbacker to kill eight people and himself in a "postal"
rampage with an AK-47 in Kentucky. Similar lawsuits were pending, and Lilly
could afford neither a negative verdict, nor the stigma of a public settlement.
So they secretly offered the plaintiffs what one lawyer called a "mind-boggling"
sum, in return for arguing a weaker case. Lilly got its not-guilty verdict, but
when its machinations came to light, a Kentucky appellate judge opined that "the
system has been tampered with," perhaps the understatement of the century.
But let's be realistic. Glenmullen is selling something, too. He hasn't
researched the effects of Prozac, he's merely assembled some of his own case
studies and critiqued the work of others. (Breggin, the author of "Talking Back
to Prozac" has accused Glenmullen of ripping him off.) Not only is Glenmullen
successfully pushing this book, he's simultaneously hawking a collection of his
own patients' sexual fantasies, called "Sexual Mysteries," on his Web site. One
of the case studies concerns "a patient's powerful sexual feelings for her
therapist." Gives pause, don't you think?
The irony is that the current
spate of bad publicity for Prozac coincides with Lilly's multimillion-dollar
reformulation and re-launch of the product. The old Prozac/Sarafem
patent is expiring, so much of the damage inflicted on the
brand will be visited upon rival drug companies hawking a
cheaper, generic Prozac. Meanwhile Lilly will be busy promoting the
as-yet-unnamed "new, improved" Prozac.
Lilly rarely acknowledges the
alleged shortcomings of Prozac, except to say - correctly, I think - that
critics have exaggerated the drug's known side effects. Yet, as
it happens, Lilly's patent filing for Prozac II says the new
drug will reduce such side effects as nervousness, anxiety,
insomnia, and "suicidal thoughts." Just a coincidence? Psychiatrists are very
skeptical about coincidences, and so am I.
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