March 26, 2008

The Zyprexa Chronicles: Two Answers For Psychosis, One Great Story

The New York Times' Alex Berenson, whom I hold in very high regard, stumbled onto an amazing real life paradox while in Alaska last week and turned it into a fascinating story. Brief summary: upstairs in the court house, Lilly was defending Zyprexa as good and safe and valuable for schizophrenics (the week before the drug had been declared unsafe and the company liable for all manner of problems according to the plaintiff's case) while downstairs a judge was conducting a commitment hearing for a man who seems to have been pretty much delusional and, ironically in the minds of many docs, an appropriate candidate for treatment with Zyprexa or a similar drug. But the judge was operating under the strictures of a fairly recent Alaska Supreme Court ruling (I wrote about this case 18 months ago. I now know that I was not exaggerating that the case, Myers v. Alaska, would have real world implications) that makes it illegal for the State of Alaska to commit people to the state hospital and give them medications that may be of harm to them, especially if less restrictive alternatives were available. The judge didn't commit the man.

The drug at the center of Myers was Zyprexa.

How could the judge commit the man with the evidence of harm caused by antipsychotics that had been laid out upstairs earlier this month? As a class, the atypical antipsychotics are not all as bad as Zyprexa (Clozaril is arguably worse), but they all have serious problems attached to their use and it appears to me that the man may suffer some of the consequences of being on these medications in the past. You read the story and tell me what you think.

If the judge had committed the man, then the man's lawyer would've had a writ up to the Alaska Supreme Court tout suite. That's simply a stunning sea change in jurisprudence and mental illness in American culture. It's also a huge experiment, practically speaking, and I hope it works out. I'm also sure that somewhere Back East Fuller Torrey is composing an op-ed.

Here's another irony: the case that resulted in the above state supreme court ruling was argued by Jim Gottstein. I'm sure most of you will recall that Gottstein is the Anchorage lawyer who passed off the Zyprexa documents to Berenson in late 2006, documents which Berenson used to detail all sorts of misbehavior by Lilly in the Times. The irony here is a bit much for me.

Anyhow, Berenson's piece is well done and you ought to read it. He does such a good job of handling the piece that I am professionally jealous. Oh, did I mention that it includes a photo of two attorneys representing Lilly?

The Alaska v. Lilly case should have its closing arguments today or tomorrow. The case would then be expected to go to the jury which is being asked to consider whether the company was liable or not of covering up risks associated with the use of Zyprexa. If the jury finds the company liable, then a separate jury will be asked to set a monetary award. More on that later.

Posted by Philip Dawdy at March 26, 2008 12:03 AM
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Comments

Berenson's article takes an interesting and important approach but it only brushes on one crucial issue which is the fact implicit in the article that the man facing commitment has never been helped by the drugs he's been forced to take or by being imprisoned in a psych hospital. The public defender in the commitment proceeding argues that "the hospital has not shown that treatment will improve him,” she said. The judge apparently reviewed the evidence and found her argument credible and futhermore found that he was able to survive outside of the hospital. I think the man has a god given right to his personality and opinions and wish him the best.

Posted by: Sally at March 26, 2008 04:24 AM

I thought it was unfortunate that the story stated that there was no debate that the man subject to commitment was "not fine". The victory Jim Gottstein won in Alaska was terrific but it does not stop Alaska from committing folks, it only makes it more difficult to force drug them. Also, it's not ironic that Jim was involved in both cases, it's connected. Go to www.psychright.org to see the connection. Jim legally obtained the Zyprexa documents in the course of litigating against forced drugging in Alaska's state hospital.

I wish we had a state in which it was not possible to commit folks to state hospitals, but such is not the case.

Posted by: Alison Hymes at March 26, 2008 06:04 AM

Having the 2 years of experience inside mental health court rooms with Judges that I do; I say BRAVO! to the Judge in Berenson's article!

That is unheard of, that Judge did a damn good thing! Keep on proving these inpatient doctors wrong with their opinions that locked up and medicated is the answer!

Posted by: Stephany at March 26, 2008 08:38 AM

I thought Alex' article said that previous experience showed that Zyprexa and other atypicals had done this man no good. I thought it also said that he (Mr. Bigley) stopped taking them as soon as he got out of the hospital and that this had happened more than once. So, though I was thrilled to have the judge support Mr. Bigley (not violent, etc) to me it was hard to tell if the drugs had ever had a fair trial. But, most of all, I was glad that Mr. Bigley has figured out a way not to be killed by Zyprexa.

Posted by: sorrowful at March 26, 2008 06:42 PM

the best part of the judge ruling, was that NO treatment helped; whether it was Zyprexa or not; Bigley was not locked up for "annoying" behavior and being a so called nuisance in "society".

The judge made a decision that I have never witnessed in mental health court, and trust me i've been there as a fly on the wall for years.

it's all about freedom and civil liberties and not forcing medication, least restrictive environments---in essence the right to remain you. However you are.

This Bigley's] story is bigger than the Zyprexa lawsuit.


reading about Bigley helps me lose some anger about the agony Zyprexa caused; it gives hope where we need to place it. [the future].

Posted by: Stephany at March 26, 2008 08:08 PM

Yes Stephany, it's a good decision and the Berenson article while not perfect is moving in the right direction. This may seem a bit tangental, but I think it's related - yesterday the Atlanta Journal had an article about how prisons were the de facto psych wards as so many prisoners are on psych drugs and labeled mentally ill. You've heard the tired rhetoric a zillion times from TAC. However, it occurs to me that everyone in prison is someone who has not been found to be "mentally ill." If they had been found to be mentally ill before prison they would have been not guilty by reason of insanity and locked in psych wards instead of prison, which finally gets me to my point, being involuntarily imprisoned whether in a prison or psych hospital causes mental illness. The prisoners aren't in prison because they're mentally ill, they're mentally ill because they're in prison. It's a similar situation in locked psych wards.

Posted by: Sally at March 27, 2008 12:27 PM
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