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In an international review article, Healy says that the idea that [[antidepressants]] might contribute to suicide in depressed patients was first raised in 1958. For 30 years antidepressants were primarily used in severely depressed and often hospitalised patients. The issue of suicidality on [[selective serotonin reuptake inhibitors]] (SSRIs) became one of public concern with reports in 1990 that [[Prozac]] could lead to suicidality in patients.<ref name=dhintrev/> Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties "during the early phase of treatment, during treatment discontinuation, and when the dose of treatment is being changed, and that treatment related risks may be present in patients being treated for syndromes other than depression, such as anxiety or smoking cessation".<ref name=dhintrev>Healy D, Aldred G (2005). [http://www.davidhealy.org.php53-23.dfw1-1.websitetestlink.com/wp-content/uploads/2012/05/2005-Healy-Aldred-Antidepressants-and-Suicide1.pdf Antidepressant drug use and the risk of suicide]. ''International Review of Psychiatry'' 17, 163–172.</ref>
In an international review article, Healy says that the idea that [[antidepressants]] might contribute to suicide in depressed patients was first raised in 1958. For 30 years antidepressants were primarily used in severely depressed and often hospitalised patients. The issue of suicidality on [[selective serotonin reuptake inhibitors]] (SSRIs) became one of public concern with reports in 1990 that [[Prozac]] could lead to suicidality in patients.<ref name=dhintrev/> Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties "during the early phase of treatment, during treatment discontinuation, and when the dose of treatment is being changed, and that treatment related risks may be present in patients being treated for syndromes other than depression, such as anxiety or smoking cessation".<ref name=dhintrev>Healy D, Aldred G (2005). [http://www.davidhealy.org.php53-23.dfw1-1.websitetestlink.com/wp-content/uploads/2012/05/2005-Healy-Aldred-Antidepressants-and-Suicide1.pdf Antidepressant drug use and the risk of suicide]. ''International Review of Psychiatry'' 17, 163–172.</ref>


In May 1984, Germany's regulatory agency (BGA) rejected Prozac as "totally unsuitable for treating depression".<ref>[http://www.baumhedlundlaw.com/01.pdf Fax from the BGA to Eli Lilly, 25 May 1984]</ref> In July 1985, [[Eli Lilly and Company|Eli Lilly's]] own data analysis—from a pool of 1,427 patients—showed high incidence of adverse drug effects and evidence of drug-induced violence in some patients.<ref>Eli Lilly internal analysis submitted to the Joachim Wernicke (2 July 1985), PZ 2441 2000. Document uncovered during Fentress litigation.</ref> In May 1985, FDA's (then) chief safety investigator, Dr. Richard Kapit, wrote: “Unlike traditional tricyclic antidepressants fluoxetine’s profile of adverse side effects more closely resembles that of a stimulant drug than one that causes sedation". He warned "It is fluoxetine’s particular profile of adverse side-effects which may perhaps, in the future give rise to the greatest clinical liabilities in the use of this medication to treat depression".<ref>Kapit R. FDA Safety Review NDA 18-963, 23 March 1985.</ref> In 1985 Dr. Kapit recommended "labeling warning [for] the physician that such signs and symptoms of depression may be exacerbated by this drug". No such warning was issued until 2004.
In May 1984, Germany's regulatory agency (BGA) rejected Prozac as "totally unsuitable for treating depression".<ref>[http://www.baumhedlundlaw.com/01.pdf Fax from the BGA to Eli Lilly, 25 May 1984]</ref> In July 1985, [[Eli Lilly and Company|Eli Lilly's]] own data analysis—from a pool of 1,427 patients—showed high incidence of adverse drug effects and evidence of drug-induced violence in some patients.{{Citation needed}}<ref>Eli Lilly internal analysis submitted to the Joachim Wernicke (2 July 1985), PZ 2441 2000. Document uncovered during Fentress litigation.</ref> In May 1985, FDA's (then) chief safety investigator, Dr. Richard Kapit, wrote: “Unlike traditional tricyclic antidepressants fluoxetine’s profile of adverse side effects more closely resembles that of a stimulant drug than one that causes sedation". He warned "It is fluoxetine’s particular profile of adverse side-effects which may perhaps, in the future give rise to the greatest clinical liabilities in the use of this medication to treat depression".<ref>Kapit R. FDA Safety Review NDA 18-963, 23 March 1985.</ref> In 1985 Dr. Kapit recommended "labeling warning [for] the physician that such signs and symptoms of depression may be exacerbated by this drug". No such warning was issued until 2004.


In February 1998, 60-year-old Donald Schell went to see his doctor complaining of difficulty sleeping. He was diagnosed with an anxiety state and placed on [[Paxil]], an SSRI. Within forty-eight hours of being put on Paxil Schell killed his wife, daughter, infant granddaughter, and himself. Tim Tobin, Schell's son-in-law, took legal action against SmithKline (now [[GlaxoSmithKline]]). Healy was retained as an expert witness in the case. The Tobin case was heard in [[Cheyenne]], [[Wyoming]] from 21 May to 6 June 2001. On the stand SmithKline representative Ian Hudson indicated that no matter how many physicians or clinicians reported to the company that they thought suicide was related to the Paxil, SmithKline would deny [[Causation in English law|causation]]. The jury returned a guilty verdict against SmithKline and awarded Tobin $6.4 million.<ref name=baum/><ref>[http://www.fitzgeraldlaw.com/file_viewer.php?id=155 Tobin v. SmithKline Verdict, June 6, 2001]</ref><ref>[http://www.fitzgeraldlaw.com/file_viewer.php?id=153 Tobin v. SmithKline Judgment, June 6, 2001]</ref><ref>{{cite web |url=http://www.fitzgeraldlaw.com/file_viewer.php?id=214 |title=Jury Awards $6.4 Million in Killings Tied to Drug |author=Philip J. Hilts |date=8 June 2001 |work=The New York Times }}</ref> This was the first verdict returned guilty against a [[pharmaceutical]] company regarding adverse behavioural effects of a [[psychotropic]] drug.<ref name=baum/>
In February 1998, 60-year-old Donald Schell went to see his doctor complaining of difficulty sleeping. He was diagnosed with an anxiety state and placed on [[Paxil]], an SSRI. Within forty-eight hours of being put on Paxil Schell killed his wife, daughter, infant granddaughter, and himself. Tim Tobin, Schell's son-in-law, took legal action against SmithKline (now [[GlaxoSmithKline]]). Healy was retained as an expert witness in the case. The Tobin case was heard in [[Cheyenne]], [[Wyoming]] from 21 May to 6 June 2001. On the stand SmithKline representative Ian Hudson indicated that no matter how many physicians or clinicians reported to the company that they thought suicide was related to the Paxil, SmithKline would deny [[Causation in English law|causation]]. The jury returned a guilty verdict against SmithKline and awarded Tobin $6.4 million.<ref name=baum/><ref>[http://www.fitzgeraldlaw.com/file_viewer.php?id=155 Tobin v. SmithKline Verdict, June 6, 2001]</ref><ref>[http://www.fitzgeraldlaw.com/file_viewer.php?id=153 Tobin v. SmithKline Judgment, June 6, 2001]</ref><ref>{{cite web |url=http://www.fitzgeraldlaw.com/file_viewer.php?id=214 |title=Jury Awards $6.4 Million in Killings Tied to Drug |author=Philip J. Hilts |date=8 June 2001 |work=The New York Times }}</ref> This was the first verdict returned guilty against a [[pharmaceutical]] company regarding adverse behavioural effects of a [[psychotropic]] drug.<ref name=baum/>

Revision as of 02:07, 10 January 2014

For other people named David Healy (disambiguation), see David Healy (disambiguation) (disambiguation).

David Healy, a professor of psychiatry at Bangor University in the UK, is a psychiatrist, psychopharmacologist, scientist and author. His main areas of research are the contribution of antidepressants to suicide, conflict of interest between pharmaceutical companies and academic medicine, and the history of pharmacology. Healy has written more than 150 peer-reviewed articles, 200 other articles, and 20 books, including The Antidepressant Era, The Creation of Psychopharmacology, The Psychopharmacologists Volumes 1–3, Let Them Eat Prozac and Mania: A Short History of Bipolar Disorder.

Healy has been involved as a expert witness in homicide and suicide trials involving psychotropic drugs, and has brought concerns about some medications to the attention of drug regulators. He has also alleged that pharmaceutical companies sell drugs by marketing diseases and co-opting academic opinion-leaders. In his 2012 book Pharmageddon he argues that pharmaceutical companies have dominated healthcare in America, often with life-threatening results for patients. Healy is a founder and chief executive officer of Data Based Medicine Limited, which aims to make medicines safer through "online direct patient reporting of drug effects".

Career

David Healy originally trained in Dublin, Ireland, and at the Cambridge University. He is a former Secretary of the British Association for Psychopharmacology.

He is currently a professor of psychiatry at Bangor University in the UK, is a psychiatrist, psychopharmacologist, scientist, and author. His main areas of research are the development and history of psychopharmacology, and the impact of psychotropic drugs on our culture. Healy has written more than 150 peer-reviewed articles, 200 other articles, and 20 books, including The Antidepressant Era and The Creation of Psychopharmacology from Harvard University Press, The Psychopharmacologists Volumes 1–3 and Let Them Eat Prozac from New York University Press, and Mania: A Short History of Bipolar Disorder from Johns Hopkins University Press.[1]

Healy has been involved as a legal expert witness in homicide and suicide trials involving psychotropic drugs, and has brought concerns about some drugs to the attention of American and British regulators. He has also raised awareness of how pharmaceutical companies sell drugs by marketing diseases and co-opting academic opinion-leaders, sometimes ghostwriting their articles. His most recent book, Pharmageddon, documents how pharmaceutical companies have dominated healthcare in America, often with life-threatening results for patients. In 2000, Healy's long-held view that SSRI antidepressants such as Prozac increase suicide risk for patients cost him a lucrative job at Toronto's Centre for Addiction and Mental Health.[2]

Healy is a founder and chief executive officer of Data Based Medicine Limited, which operates through its website RxISK.org, which aims to make medicines safer through "online direct patient reporting of drug effects". Healy sits on the Honorary International Editorial Advisory Board of the Mens Sana Monographs.[3]

Research interests and publications

SSRI Antidepressants and suicide

In an international review article, Healy says that the idea that antidepressants might contribute to suicide in depressed patients was first raised in 1958. For 30 years antidepressants were primarily used in severely depressed and often hospitalised patients. The issue of suicidality on selective serotonin reuptake inhibitors (SSRIs) became one of public concern with reports in 1990 that Prozac could lead to suicidality in patients.[4] Fourteen years later, warning labels were put on antidepressants suggesting particular difficulties "during the early phase of treatment, during treatment discontinuation, and when the dose of treatment is being changed, and that treatment related risks may be present in patients being treated for syndromes other than depression, such as anxiety or smoking cessation".[4]

In May 1984, Germany's regulatory agency (BGA) rejected Prozac as "totally unsuitable for treating depression".[5] In July 1985, Eli Lilly's own data analysis—from a pool of 1,427 patients—showed high incidence of adverse drug effects and evidence of drug-induced violence in some patients.[citation needed][6] In May 1985, FDA's (then) chief safety investigator, Dr. Richard Kapit, wrote: “Unlike traditional tricyclic antidepressants fluoxetine’s profile of adverse side effects more closely resembles that of a stimulant drug than one that causes sedation". He warned "It is fluoxetine’s particular profile of adverse side-effects which may perhaps, in the future give rise to the greatest clinical liabilities in the use of this medication to treat depression".[7] In 1985 Dr. Kapit recommended "labeling warning [for] the physician that such signs and symptoms of depression may be exacerbated by this drug". No such warning was issued until 2004.

In February 1998, 60-year-old Donald Schell went to see his doctor complaining of difficulty sleeping. He was diagnosed with an anxiety state and placed on Paxil, an SSRI. Within forty-eight hours of being put on Paxil Schell killed his wife, daughter, infant granddaughter, and himself. Tim Tobin, Schell's son-in-law, took legal action against SmithKline (now GlaxoSmithKline). Healy was retained as an expert witness in the case. The Tobin case was heard in Cheyenne, Wyoming from 21 May to 6 June 2001. On the stand SmithKline representative Ian Hudson indicated that no matter how many physicians or clinicians reported to the company that they thought suicide was related to the Paxil, SmithKline would deny causation. The jury returned a guilty verdict against SmithKline and awarded Tobin $6.4 million.[8][9][10][11] This was the first verdict returned guilty against a pharmaceutical company regarding adverse behavioural effects of a psychotropic drug.[8]

Healy has written many papers and presented many lectures on his view that all SSRI antidepressants – Prozac, Paxil and Zoloft – should show warning labels, as they could "trigger suicidal and violent behavior in some patients".[8] Some of Healy's more recent refereed journal articles on antidepressants and suicide include:[12]

  • Healy D (2000). Good Science or Good Business? Hastings Center Report 30, 19–23.
  • Healy D (2000). Antidepressant induced suicidality. Primary Care Psychiatry 6, 23–28.
  • Boardman A, Healy D (2001). Modeling suicide risk in affective disorders. European Psychiatry 16, 400–405.
  • Healy D (2003). Lines of Evidence on SSRIs and Risk of Suicide. Psychotherapy and Psychosomatics 72, 71–79.
  • Healy D, Cattell D (2003). The Interface between authorship, industry and science in the domain of therapeutics. British Journal of Psychiatry 182, 22–27.
  • Healy D, Whitaker CJ. (2003) Antidepressants and suicide; Risk-Benefit Conundrums. J Psychiatry & Neuroscience 28 (5) 331–339, with response by Y Lapierre 340–349.
  • Fergusson D, Doucette S, Cranley-Glass K, (2005). The association between suicide attempts and SSRIs: A systematic review of 677 randomised controlled trials representing 85,470 participants. British Medical Journal 330, 396–399.
  • Healy D, Aldred G (2005). Antidepressant drug use and the risk of suicide. International Review of Psychiatry 17, 163–172.
  • Healy D, Herxheimer A, Menkes D (2006). Antidepressants and violence: Problems at the interface of medicine and law. PLoS Medicine 3, September
  • Healy D (2006). Manufacturing Consensus. Culture, Medicine and Psychiatry 30, 135–156.
  • Healy D, Harris M, Tranter R, Gutting P, Austin R, Jones-Edwards G, Roberts AP (2006). Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared. British Journal of Psychiatry 188, 223–228. With Commentary by T Turner, 229–230.
  • Reseland S, Le Noury J, Aldred G, Healy D (2008). National suicide rates 1961–2003: further analysis of Nordic data for suicide, autopsies and ill-defined death rates. Psychotherapy and Psychosomatics 77, 78–82
  • Healy D (2009). Trussed in Evidence: Ambiguities at the interface of clinical practice and clinical evidence. Transcultural Psychiatry 46, 16–37.
  • Healy D, Brent D (2009). Are Selective Serotonin Reuptake Inhibitors a risk factor for adolescent suicides? Canadian Journal of Psychiatry 54, 69–71.
  • Healy D (2009). Perplexity is our product. Canadian Journal of Psychiatry 54, 76.
  • Healy D (2011). Science, rhetoric and the causality of adverse events. International J Risk & Safety in Medicine 24, 1–14.

Conflict of interest

Healy says that the pharmaceutical industry has a pervasive influence on academic medicine. Most of the authors published in the Journal of the American Medical Association have received research funding from, or acted as a consultant for, a drug company.[13] These links with the pharmaceutical industry may compromise the researcher's independence and call into question their published results. Major journals have expressed concern at the ghostwriting of and conflicting interests surrounding pharmacotherapeutic studies, especially in psychiatry.[13]

Medical ghostwriting occurs when anonymous scribes with scientific backgrounds are paid to produce reports for publication as if written by better-known experts. Healy estimates that up to 50 percent of literature on drugs is ghostwritten.[14] In his thesis, he states that ghostwriters write on research given to them by drug companies, which want both positive results and positive research; therefore ghostwriting is biased from the beginning.

Healy encountered ghost writing involving Wyeth's SNRI Effexor. Healy attended a meeting promoting Effexor, and was offered for his approval a draft article that had been written for him. He left it intact, but made two additions. One contradicted Wyeth's claim that Effexor got patients fully well compared to patients on other SSRIs and another stated that SSRIs could make some individuals suicidal. The article had already been submitted to the Journal of Psychiatry and Neuroscience before Healy saw it again; both of his additions had been removed. In response Healy removed his name from the article.[15]

In the preface of his book Let them Eat Prozac Healy describes the need for a "new contract between society and the pharmaceutical industry – a contract that will require access to the raw data". Healy suggests a new division that can manage the hazards that only becomes visible after products are launched. This new division would be separate from the regulatory bodies and pharmaceutical companies. In "Interface between authorship, industry and science in the domain of therapeutics"[16] a paper of 2003 for The British Journal of Psychiatry, David Healy notes that :

"The literature profiles and citation rates of industry-linked and non-industry-linked articles differ. The emerging style of authorship in industry-linked articles can deliver good-quality articles, but it raises concerns for the scientific base of therapeutics ... If ghostwriting is an inevitable feature of modern scientific writing, the potential availability of the raw data would do more to ensure a correspondence between those data and a published end result than could be achieved by any other mechanism".[16]

Some of Healy's recent articles on conflict of interest include:[12]

  • Healy D (2004). Conflicting Interests: The evolution of an issue. Monash Review of Bioethics 23, 8–18.
  • Healy D (2004). Perspective. Manufacturing Consensus. Hasting Center Reports July–August, 53.
  • Healy D (2006). Manufacturing Consensus. Culture, Medicine and Psychiatry 30, 135–156.
  • Healy D (2006). The Latest Mania. Selling Bipolar Disorder. PloS Medicine.
  • Healy D (2007). The New Engineers of Human Souls and Academia. Epidemiologia e Psichiatria Sociale 16. 205–211.
  • Healy D, Le Noury J (2007). Paediatric Bipolar Disorder. An object of study in the creation of an illness. Int J Risk & Safety in Medicine 19, 209–221.
  • Healy D (2008). Our Censored Journals. Mens Sana Monographs 6, 244–256
  • Healy D (2008). Irrational Healers? Psychotherapy and Psychosomatics 77, 198–200.
  • Healy D (2009). Trussed in Evidence: Ambiguities at the interface of clinical practice and clinical evidence. Transcultural Psychiatry 46, 16–37.
  • Healy D, Mangin D, Mintzes B (2010). The ethics of randomised placebo controlled trials of antidepressants with pregnant women. Internat J of Risk and Safety in Medicine 22, 7–16.
  • Healy D (2012). Medical Partizans? Why doctors need conflicting interests. Australian & New Zealand Journal of Psychiatry 46(8) 704–707.

History of pharmacology

In his book 2012 Pharmageddon, Healy discusses the well-publicised birth defects crisis caused by thalidomide, a drug initially marketed as a sleeping pill. The 1962 disaster involved more than 10,000 children in 46 countries being born limbless and disabled. The United States Congress wanted to prevent a recurrence of such a tragedy, and sought to limit the marketing excesses of the pharmaceutical industry. So new drug development was rewarded with product rather than process patents, and new drugs were made available only through prescription. Also, new medications had to prove they worked through controlled trials before they reached the market. On the 50th anniversary of the 1962 FDA bill enacted by Congress, Pharmageddon shows how these arrangements have not been successful and have actually led to an escalating number of drug induced deaths and injuries.[17] In the same book, "Pharmageddon," on page 155, Healy states that life expectancy for the seriously mentally ill in the United States has dropped dramatically in the last fifty years, rather than increasing.

Some of Healy's recent articles on the history of pharmacology include:[12]

  • Healy D, Harris M, Tranter R, Gutting P, Austin R, Jones-Edwards G, Roberts AP (2006). Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared. British Journal of Psychiatry 188, 223–228. With Commentary by T Turner, 229–230.
  • Tschinkel S, Harris M, Le Noury J, Healy D (2007). Postpartum Psychosis: Two Cohorts Compared, 1875–1924 & 1994 – 2005. Psychological Medicine 37, 529–536.
  • Farquhar F, Le Noury J, Tschinkel S, Harris M, Kurien R, Healy D (2007). The incidence and prevalence of manic-melancholic syndromes in North West Wales: 1875–2005. Acta Psychiatrica Scandinavia 115, (suppl 433), 37–43.
  • Linden S, Harris M, Whitaker C, Healy D (2010). Religion and psychosis. The effects of the Welsh Religious Revival 1904–1905. Psychological Medicine 40, 1317–1324.
  • Harris M, Farquhar F, Healy D, Le Noury J, Baker D, Whitaker CJ, Linden S, Green P, Roberts AP (2011). The incidence and prevalence of admissions for Melancholia in two cohorts 1875–1924 & 1995–2005. J of Affective Disorders, 134, 45–51.
  • Healy D, Le Noury J, Linden SC, Harris, M, Whitaker C, Linden D, baker, D & Roberts AP (2012) The Rise and Fall in the Incidence of Admissions for Schizophrenia: 1875–1924 & 1994–2010. BMJ Open.
  • Healy, D., Le Noury, J., Harris, M., Butt, M., Linden, S., Whitaker, C., Zou, L. & Roberts, AP. (2012) Mortality in schizophrenia and related psychoses: data from two cohorts, 1875–1924 & 1994–2010. BMJ Open.

Books

  • The Suspended Revolution: Psychiatry and Psychotherapy Re‑examined, Faber & Faber, London 1990.
  • Images of Trauma: From Hysteria to Post‑traumatic Stress Disorder. Faber & Faber, London, 1993.
  • Psychotropic Drug Development; Social, Economic and Pharmacological Aspects. Chapman and Hall, London 1996.
  • The Psychopharmacologists Volume 1, Chapman & Hall, London, 1996; Arnold, London, 2002
  • The Psychopharmacologists Volume 2. Chapman & Hall, London, 1998; Arnold, London 1999.
  • The Psychopharmacologists Volume 3. Arnold, London 2000.
  • The Rise of Psychopharmacology & The Story of the CINP, Animula, Budapest, 1998.
  • The Triumph of Psychopharmacology & The CINP, Animula, Budapest, 2000.
  • From Psychopharmacology to Neuropsychopharmacology & The Story of the CINP, Animula, Budapest, 2002.
  • Reflections on Twentieth Century Psychopharmacology, Animula, Budapest, 2004.
  • The Creation of Psychopharmacology (Paperback 2004) ISBN 978-0674015999
  • Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression New York University Press (2004) ISBN 978-0814736975
  • Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Rutgers University Press/ University of Toronto Press 2007.
  • Mania: A Short History of Bipolar Disorder Johns Hopkins University Press (Paperback 2010) ISBN 978-1421403977
  • Psychiatric Drugs Explained Churchill Livingston (Paperback 5th ed. 2011) ISBN 978-0702041365
  • Pharmageddon University of California Press(2012) ISBN 978-0520270985

See also

References

  1. ^ Dr David Healy Bio
  2. ^ Sept 24th 2001 Press Conference Transcript
  3. ^ Hon Int Ed Adv Board of the Mens Sana Monographs
  4. ^ a b Healy D, Aldred G (2005). Antidepressant drug use and the risk of suicide. International Review of Psychiatry 17, 163–172.
  5. ^ Fax from the BGA to Eli Lilly, 25 May 1984
  6. ^ Eli Lilly internal analysis submitted to the Joachim Wernicke (2 July 1985), PZ 2441 2000. Document uncovered during Fentress litigation.
  7. ^ Kapit R. FDA Safety Review NDA 18-963, 23 March 1985.
  8. ^ a b c Anne Thompson (9 July 2001). "Paxil Maker Held Liable in Murder/Suicide". Lawyers Weekly USA.
  9. ^ Tobin v. SmithKline Verdict, June 6, 2001
  10. ^ Tobin v. SmithKline Judgment, June 6, 2001
  11. ^ Philip J. Hilts (8 June 2001). "Jury Awards $6.4 Million in Killings Tied to Drug". The New York Times.
  12. ^ a b c David Healy's Website
  13. ^ a b Healy D, Thase M (2003). Is academic psychiatry for sale? British J Psychiatry 182, 1–3.
  14. ^ Antony Barnett Revealed: how drug firms 'hoodwink' medical journals The Observer, 7 December 2003.
  15. ^ Sarah Boseley 'It said the drug was the best thing since sliced bread. I don't think it is' Guardian, 7 February 2002
  16. ^ a b Healy, D., & Cattell, D.Interface between authorship, industry and science in the domain of therapeutics The British Journal of Psychiatry (2003) 183: 22–27.
  17. ^ Pharmageddon

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