Trials illustrate two views of best-selling schizophrenia medicine

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International Herald Tribune
Trials illustrate two views of best-selling schizophrenia medicine
By Alex Berenson
March 24, 2008

Two courtrooms, two floors of the Nesbett courthouse, two views of Zyprexa.

In courtroom 403, lawyers read corporate memos to the jury deciding the fate of a lawsuit brought by the state of Alaska, which was charging the drug maker Eli Lilly with hiding the dangers of Zyprexa, its best-selling schizophrenia medicine.

At the same time, in courtroom 301, William Bigley had his own opinions on Zyprexa and on the other drugs he has taken since 1980 to battle demons that only he can see. On March 14, a state court judge was to decide whether Bigley should be held for 30 days in a psychiatric hospital.

Bigley, 55, told the judge that the drugs were "poison" and that he did not need them. "I'm fine," he said. His words were undercut, however, by regular claims to having seen flying saucers and to knowing that President George W Bush owned a private jet.


Downtown Anchorage, Alaska
Of all the facts at issue in the two courtrooms, one was beyond debate. Bigley was not fine.

Even so, the hearing in the Bigley case offered a textbook illustration of the agonizing choices mentally ill patients face as they consider whether to take Zyprexa or other antipsychotics.

By calming the hallucinations and delusions that plague people with schizophrenia, drugs like Zyprexa allow many patients to live outside psychiatric institutions. But the documents discussed in room 403 offered plenty of evidence that Bigley, whatever his delusions, had good reason to dislike the medicines.

All antipsychotics have side effects, and Zyprexa's are among the worst, according to the American Diabetes Association and to independent scientists. In many patients, Zyprexa causes severe weight gain that can lead to diabetes, as well as sharply higher cholesterol and triglyceride levels in the blood. Those are all risk factors for heart disease.

Furthermore, the documents introduced in courtroom 403 showed that for much of the past decade, Lilly executives played down those risks. Among themselves, in internal e-mail messages and memos, they shared worries that sales of Zyprexa would fall if the drug were linked to weight gain or diabetes.

In 2002, for example, the Japanese government ordered Lilly to warn Japanese physicians against giving Zyprexa to people at high risk for diabetes. But Lilly did not add a similar warning to Zyprexa labels in the United States. Internally, Lilly executives acknowledged that the warning had hurt Zyprexa sales in Japan.

"The impact of the label change in Japan has been very profound," two senior Lilly executives wrote in a memo on July 1, 2002. "There has been a 75% drop in new patients who are being put on the drug."

Indeed, with U.S. doctors learning on their own about the connection between Zyprexa and diabetes, prescriptions for the drug have fallen 50 percent since 2003.

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