The following post is by Dr. David Egilman, a familiar figure to those who have been following the case of Eli Lilly’s schizophrenia drug Zyprexa. See Alex Berenson’s New York Times articles on the case for more background, or read David Michaels’s post about Zyprexa and sequestered science. — Editor

“The Truth is Not Free”
By David Egilman
September 11, 2007

All that is needed for the forces of evil to succeed is for enough good people to remain silent.
– Edmund Burke

The consequences of silence can be devastating.  My father spent WWII in a German concentration camp largely as a consequence of silence. In response to the Holocaust, which was facilitated by the silence of a nation, I have devoted much of my professional career to studying and reporting the effects of silence on public health.

Last December, I was subpoenaed for copies of internal documents that I acquired as a consulting witness in litigation against the pharmaceutical company Eli Lilly. I released all of the documents I had, which made their way to The New York Times and became the basis for four major articles. After the Times stories ran, 30 states subpoenaed documents detailing Lilly’s sales, marketing and promotional practices for Zyprexa as part of civil investigations under state consumer protection laws.

I recently reached a settlement with Lilly and agreed to pay the company $100,000. I admitted responsibility for violating the protective order that kept Lilly’s documents secret.  I admitted that the documents I leaked did not tell the full story about Zyprexa. I did not, however, admit that Lilly’s “story” of the drug is based on fact, nor did I admit to any illegal conduct.  And notably, although Lilly claims that the stories that ran in the Times did not accurately reflect its marketing practices or its knowledge of Zyprexa’s side effects, Lilly has refused to release documents that it claims paint a different picture.  Even today, Lilly fights in court to keep those documents secret from the public.

However, I refuse to silence my voice on the dangerous effects of corporate secrecy. History has demonstrated time and time again that such silence brings nothing but harm.

The silence of asbestos companies and their doctors, who hid their knowledge of the hazards of asbestos, permitted a carcinogen to be used for a century in schools, homes and offices. The entire town of Libby, Montana fell victim to that silence. Too late, litigation revealed what companies and their doctors had known for over a hundred years. Asbestos was killing thousands.

The silence of flavoring companies and their doctors, who hid their knowledge of the hazards of butter flavored popcorn, allowed these toxic foods to be sold to an unsuspecting public for more than 20 years. The recent outbreak of lung disease in consumers of butter flavored popcorn is the cost of this silence. Yet litigation revealed the truth – these companies had known the flavorings caused disease for decades. In this case, there may still be time to avoid another asbestos-like epidemic.

The silence of Eli Lilly & Company and their doctors about the hazards of Oraflex, a drug they knew caused fatal liver failure, resulted in unnecessary deaths of American patients. Once again, litigation revealed the truth. Lilly pleaded guilty to 25 criminal charges of failing to inform the United States government about adverse reactions to Oraflex and mislabeling the drug. 

The same story keeps repeating itself. Over the years, silica, lead, tobacco, pesticides, beryllium, Vioxx, Oraflex and hundreds of other toxic products have ended up in our food, our medicine, our air and our water. It is the silence of corporations and their doctors, not a lack of knowledge, which is the root cause of this never-ending circle of public health disasters.

This blanket of silence is becoming so heavy that doctors are forgetting where their loyalties lie. The medical director of one asbestos company was asked why he hadn’t warned his patients, those who developed asbestosis and cancer from their work, of the hazards of asbestos. He explained that he had indeed warned his patients; that the company was his “patient.” I refuse to go the way of that doctor and remain silent on issues important to the public health, for the cost is always the loss of innocent lives.

When I graduated from medical school, I took an oath to protect the public health. That oath supersedes all other agreements, including those that prevent me from protecting public health by releasing information.  My obligation to the health and safety of others is the same as that of a physician who informs the police about a patient who has “in confidence” threatened injury on another. My obligation is the same as that of a pediatrician who “violates” confidentiality to report possible child abuse to the police.   

If Lilly has “secret” documents that indicate that its drugs are safe or that their marketing practices were appropriate, they have the right to release them and it is in their interest to do so. Their silence is deafening. 

Silence can injure and kill. For public health, the sound of silence is the funeral dirge.  I have not and will never play that tune.

All that is needed for the forces of evil to succeed is for enough good people to remain silent.
David S. Egilman, MD, MPH is Clinical Associate Professor at Brown University’s Department of Community Health.