A world-renowned scientist saw a job offer at the University of Toronto evaporate after warning that the popular antidepressant Prozac may trigger suicide in some patients.
The drug's manufacturer, Eli Lilly, is an important private donor to a mental-health research institute affiliated with the university.
Critics say it appears that David Healy's job offer was rescinded to avoid offending the corporate giant or for fear of compromising future fundraising efforts.
Eli Lilly said it had no role in the matter.
The university said the decision not to hire Dr. Healy was made by the Centre for Addiction and Mental Health, an affiliated teaching hospital, and that it would not be proper for the university to question it. The Centre for Addiction and Mental Health, for its part, steadfastly denies that it has allowed fundraising concerns to interfere with academic freedom.
"If you are asking me if his comments influenced our decision, let me be clear that there were a number of factors involved. We regret that our actions have been misinterpreted as an attack against academic freedom and as a conflict of interest," said Paul Garfinkel, chief executive officer of the CAMH.
Dr. Garfinkel said the reasons for the decision to revoke Dr. Healy's job offer are confidential. "Let me be clear, we've never made an offer or withdrawn an offer on the basis of an impact on an outside donor."
When initially approached by The Globe and Mail several months ago, Dr. Healy, who works at the University of Wales, was reluctant to speak publicly about what happened.
He said he decided to do so to publicize his concerns about Prozac and to raise questions about the appearance of a conflict of interest at U of T.
"I've had people call from a number of countries asking whether it is safe to say something [critical]about pharmaceutical companies. The public needs to know what happened here," Dr. Healy said in an interview.
Dr. Healy said he made his views clear in private interviews with university officials before the speech.
University of Toronto colleagues are providing a public platform for him to express his views on Prozac next week. He will give a lecture at the Joint Centre for Bioethics on Thursday evening.
U of T and CAMH had been courting Dr. Healy since July of 1999. They made him a formal written offer of a combined faculty and clinical position in May of 2000, followed by a more detailed letter in August. They hired a lawyer to help him immigrate.
Then, on Nov. 30, 2000, Dr. Healy gave a wide-ranging lecture at CAMH, part of a colloquium titled Looking Back, Looking Ahead -- Psychiatry in the 21st Century: Mental Health and Addiction.
He criticized pharmaceutical companies for avoiding experiments that could demonstrate problems with their drugs, and for not publishing unfavourable results. He said the data show that Prozac and other popular antidepressants in the same chemical family may have been responsible for one suicide for every day they have been on the market.
A week later, Dr. David Goldbloom, physician-in-chief at CAMH and a professor at U of T, rescinded the offer to Dr. Healy in an e-mail, a copy of which was sent to The Globe and Mail in an unmarked brown envelope.
Dr. Goldbloom told Dr. Healy his lecture was evidence that his approach was not "compatible" with development goals. Development, in the university context, is widely understood to mean fundraising, although CAMH denies that fundraising was what was meant.
Eli Lilly, the drug company that manufactures Prozac, is its "lead" donor according to the CAMH Web site, contributing more than $1-million to the centre's $10-million capital-fundraising campaign.
Last year, Eli Lilly cancelled its $25,000 (U.S.) annual donation to the Hastings Center in New York, a think tank that looks at ethical issues, after it published a series of articles about Prozac, including a critical one by Dr. Healy titled Good Science or Good Business.
"The centre had published articles that Lilly felt contained information that was biased and scientifically unfounded and that may have led to significant misinformation to readers, patients and the community," said Laurel Swartz, manager of corporate communications for Eli Lilly.
Two U of T professors, who have asked that their names not be published, said that what happened to Dr. Healy in Canada raises disturbing questions about whether professors are free to be critical of drug companies in an era where medical schools are heavily dependent on them for financing.
James Turk, executive director of the Canadian Association of University Teachers, said the paper trail appears to make it clear why Dr. Healy was no longer welcome at U of T.
"The language they use indicates they feel they can't hire this guy because it will give them trouble raising money," Mr. Turk said.
Experts such as Bob Michels, the former head of medicine at Cornell University in New York, say Dr. Healy is internationally renowned, both as a clinical psychopharmacologist and a historian of the role of drugs in modern psychiatry.
He is also well-known for his outspoken criticism of Prozac and other similar drugs and has appeared as an expert witness on behalf of families suing Eli Lilly and other drug companies.
Dr. Healy says the data show Prozac and related medications, which are widely prescribed for people who in the past would not be deemed sick enough to require medication, can cause patients with no history of mental illness to fall into a state of extreme agitation anxiety. In some cases it can lead to suicide, or thoughts of suicide.
Last year, Dr. Healy published a study that found that two healthy volunteers out of 20 who were given Prozac reported feeling extremely anxious and that they entertained thoughts of suicide.
Eli Lilly says Prozac is safe. "There is no credible scientific evidence that establishes a causal link between Prozac [fluoxetine hydrochloride]and violent or suicidal behaviour," Ms. Swartz said.
Dr. Healy insists warning labels are needed on Prozac so doctors will know to watch for suicidal tendencies when they prescribe the antidepressant.
His speech did not go over well at U of T. Dr. Healy said Dr. Goldbloom appeared unhappy when they discussed the lecture at a dinner that evening.
Dr. Healy said he understood Dr. Goldbloom to be critical of his speech because people would take away from it the understanding that Prozac makes people suicidal and the Eli Lilly knew about the problem but wouldn't acknowledge it.
Dr. Healy left that weekend for New York, where he was scheduled to give the same speech at Cornell University.
On the Monday after the Thursday speech, Dr. Goldbloom began sending Dr. Healy e-mails saying it was urgent they find a time to talk by telephone. Dr. Healy kept copies of them, and has provided them to The Globe and Mail.
When the two men couldn't arrange the phone call, Dr. Goldbloom sent the e-mail rescinding the job offer on behalf of both CAMH and U of T.
"Essentially, we believe that it is not a good fit between you and the role of leader of an academic program in mood and anxiety disorders at the Centre and in relation to the University. This view was solidified by your recent appearance at the Centre in the context of an academic lecture," the message said.
"While you are held in high regard as a scholar of the history of modern psychiatry, we do not feel your approach is compatible with the goals for development of the academic and clinical resource that we have."
Dr. Goldbloom would not be interviewed for this story. Dr. Garfinkel said he didn't know what Dr. Goldbloom had said to Dr. Healy in person after the speech. But he categorically denied that when Dr. Goldbloom referred to the development of the centre he was referring in any way to the ability to raise funds, either from Eli Lilly or other drug companies.
"Development is a technical term that many places use to talk about fundraising. This is development of a program, totally different meaning," Dr. Garfinkel said.
He said the meeting where senior managers from U of T and CAMH made the decision to rescind the job offer was on Dec. 8. Yet Dr. Goldbloom sent the e-mail on Dec. 7, and began requesting an interview by phone several days before that.
Dr. Healy didn't quit his job in Wales and said he is not planning legal action. He said he has asked for a more detailed explanation about why the job offer was rescinded, but none was given. He said he would like to hear from Dr. Garfinkel about the confidential reasons the job offer was revoked.
"Nobody has offered me any other reasons at all. I don't believe there are any other reasons. We have the paper trail, and what I am asking them to explain is the paper trail. Maybe there is an explanation that will let them off the hook, but if there is, maybe they could try explaining it to me."
He certainly never imagined that his speech, which contained nothing he hasn't said before, would cost him the job.
In fact, Dr. Michels said the same speech did not cause problems at Cornell.
"He certainly has many people who sharply differ with him. That's not unusual in science. He has points of view that other people don't agree with. He has certainly been very open and expressive about his points of view. The material is an area where there is great controversy, and he takes positions in that controversy, but they are well within the dialogue in his field."
This is the second controversy of its kind at the university. Researcher Nancy Olivieri faced an ugly internal battle and a lawsuit when she published data unfavourable to the drug company that funded her work.