Alaska - Zyprexa - Two Courtrooms

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International Herald Tribune

Trials illustrate two views of best-selling schizophrenia medicine

By 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, 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 W Bush owned a private jet.

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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