Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial Read online

  Even so, reading Victor's file and others like it turned her stomach. In one of the court filings on the case, a psychiatric expert had testified that Haldol, with its severe side effects, should not have been prescribed to a teenager, much less a twelve-year-old who had just lost his father. It was only intended for use in extreme cases of psychosis. Maybe this particular boy needed Haldol; Firestein knew she couldn't make that call. What bothered her was that so many of these children seemed to be drugged so they wouldn't make problems for their caregivers. Drugs like Haldol were being used as chemical straitjackets. Yet there was no one around to supervise this usage, to make sure these children didn't overdose or develop potentially dangerous side effects. And that, to Firestein, was the real crime.

  LEGAL AID WON a preliminary injunction with its lawsuit, and after a week-long trial that embarrassed Mayor Ed Koch and other city officials, the city finally agreed to stop the practice of keeping foster children overnight in field offices. But many children were still being held in DSS field offices during the day -the court order stipulated only that they had to be moved to an overnight placement by 11 p.m. -and conditions in those offices had not improved much. Firestein could remember her horror at walking into field offices in Bedford-Stuyvesant, the South Bronx, Queens it didn't matter and finding cockroaches, expired baby formula, inadequate care for the HIV-positive children, even multiple babies in one crib.

  As an accomplished cook, Firestein was especially disturbed by the bad food these children were served: hot dogs, baked beans, and potato chips were staples, often washed down with sugar-laden fruit drinks. There was no security in the field offices, and one time, a neglected baby who had been removed from his mother's custody was snatched back in broad daylight. Other times, Firestein and her colleagues would arrive at the Bedford-Stuyvesant field office only to find some of the kids hanging around outside in an area reputed to be the hub of the neighborhood's drug and gang activity. The department's caseworkers were as upset about the conditions and lack of resources as Firestein was, but no matter how many times she or another of the Legal Aid attorneys called to complain that the department was in violation of its court settlement, nothing seemed to change.

  So in 1989, Legal Aid decided to file a legal motion to have the city and its Social Services Department held in contempt of court. Firestein and her colleagues worked on the contempt motion around the clock for weeks. They set up a booth in a diner right around the corner from the Emergency Children's Services office on Laight Street in Soho, and one by one, caseworkers from ECS would drop by after their shifts and spill the beans on what was going on in the field offices. The caseworkers had the express permission of their union representative to talk to Legal Aid; all it took was a slice of pie and some sympathetic questions to open the floodgates.

  BY THE TIME Firestein pulled her working-into-the-wee-hours maneuver, she and her team had collected dozens of affidavits from these employees. The contempt motion was almost ready to be filed.

  As Firestein walked down Broadway looking for a cab, she wondered when she would get her life back. After moving to New York from Georgia, she had looked forward to meeting men who didn't view her as a carpetbagger, an opinionated Yankee who didn't even know how to flirt. But although she had dated on and off during her first few years in New York, her job at Legal Aid had become all-consuming of late.

  Firestein felt a sudden frisson of anxiety. It wasn't just the late hour; something else nagged at the edges of her consciousness. And then it hit her. She'd been mugged not far from here a few months earlier. She'd come into work especially early that morning, and the sky was just turning a pearly gray when a scraggly-looking man rushed up and demanded all her money.

  "I have a gun," he threatened. Firestein squinted at the man. She didn't see any gun. So she reacted instinctually. Instead of handing him her purse, she started screaming. An employee from a nearby bagel shop heard her and came rushing out. He chased the man away, and Firestein bought a bagful of bagels in gratitude.

  Now, a cab finally pulled up to the curb. Firestein jumped in and told him where she wanted to go.

  "Sorry, lady, I don't go to Brooklyn," the cabbie said.

  "Oh, c'mon, please? It's late and I'm really tired," Firestein pleaded with him. It wasn't the first time this had happened to her. At that hour of the night, many cab drivers didn't want to go to Brooklyn, even though they were legally obliged to, because they knew they wouldn't find a fare back to Manhattan.

  "Nope"

  Firestein didn't have the energy to write down the cabbie's medallion number and report him. She knew from experience that it wouldn't do any good anyway. Feeling fatigue in every bone of her body, she slowly slid out of the backseat and slammed the door shut. Damn! What was she going to do now? There was no way she was going to take the subway and switch trains at this hour. She began trudging back up Broadway, holding one arm in the air as she walked. Just as she was about to give up and turn back down Park Row toward the office, a taxi careened to a stop in front of her. Firestein got in and gave the cabbie her address, holding her breath. This time, the driver merely nodded and took off. Firestein settled back into the ripped leather seat and promptly fell asleep.

  Howard could tell that Maria was awake, even though her daughter's bedroom was down the hall from the kitchen. Maria was slamming doors as she moved between her room and the bathroom. It was a hot Saturday in August and Howard had been hurrying to finish a grant proposal before her fifteen-yearold daughter woke up. Howard's job was to develop outreach programs for Coastline Elderly Services, a nonprofit group that assisted senior citizens living on fixed incomes in the poor, heavily immigrant New Bedford area of southern Massachusetts. She found she had a knack for writing grant proposals that brought in much-needed funding to the organization. Today, she was up against a tight deadline. But she had the feeling she wasn't going to get any more writing done.

  A few minutes later, Maria stormed into the kitchen.

  "It's fucking hot in here!" she raged. "What's wrong with this place?"

  Howard sighed.

  "You're right," she said. It didn't pay to argue with Maria when she was in one of her moods. "It really is hot"

  Maria's dark, brooding eyes fell on the thermostat on the wall next to the doorjamb. With an angry lunge, she reached over and grabbed the round, glass-covered dial. Howard tried to intervene, but too late. With a strength that belied her slender, five-foot frame, Maria ripped the thermostat out of the wall, threw it on the floor, and ran out of the house. Howard gazed numbly at the hole in the wall, the plaster crumbling around it.

  She felt hopeless at times like these. Maria, whom Howard had legally adopted in 1988, had been growing steadily worse over the past few years, and now she was out of control. The child of a Cape Verdean woman who was mentally ill and a Nipmuc Indian father who had abandoned the family, Maria, along with her two siblings, had landed in foster care after their mother had a breakdown and was taken in a straitjacket to Taunton State Hospital. Maria ended up on Donna Howard's doorstep on a hot July afternoon in 1984. A social worker with the Massachusetts Department of Social Services, who knew of Howard's experience as a foster parent for special-needs children, had called her in desperation.

  "Please, you've got to help me," the social worker said. "A foster family has just dumped an eight-year-old girl here. They've refused to take her back, and I have absolutely no place to put this kid. She's bounced out of every placement I've put her in. I'm desperate. Can you take her for just one night?"

  An hour later, Maria was standing at Howard's door, clutching a grubby stuffed animal. Skinny and petite, with belligerent eyes and silky black hair, the little girl demanded to know what Howard's rules were. And she reminded her that she was only staying for one night.

  That had been six years ago, and Maria was still with Howard. Donna had long wanted a child of her own. Thirty-five and unmarried, Howard was a statuesque woman with expressive green eyes and a silvery laug
h. Both her parents were deceased, and she'd been on her own for some time.

  When her father, a British-born sailor for the U.S. Navy, was still alive, Howard had won his respect by being the first in their family to earn a college degree. Her mother had died when Donna was only fourteen, and it was her father to whom she looked for love and approbation. He spent weeks away at sea, but when he was home, he was her biggest fan. He would take her and her older sister shopping for clothes, and he cooked them dinner. Although he didn't have much money, he helped Donna pay for college and the graduate-level courses in public administration that she excelled in. Hired as an outpatient coordinator at an acute care hospital in New Bedford, she rose quickly, becoming first the patient services supervisor and then the hospital's admissions manager, in charge of a staff of thirty people. But there was emptiness in Donna Howard's heart. Her father was often gone, her older sister had left the state, and Donna wanted a family of her own. Somehow she doubted she would ever meet the right man. In June 1984, she left the hospital and accepted a job directing an alternative education program for low-income children. In her spare time, she took in foster children with special needs. Then Maria turned up on her doorstep.

  By the time Howard adopted Maria, she understood that raising her would be no picnic. At elementary school, Maria regularly picked fights with her teachers and classmates. She couldn't seem to sit still or even stay in a classroom for a fixed period of time. She would periodically run outside and hide. School officials, exasperated by Maria's behavior, kept trying to expel the child. Howard had to threaten to take the school district to court to keep her daughter enrolled. Life with Maria seemed to be crisis after crisis.

  Howard soon discovered that the one thing that seemed to soothe her daughter's spirit was water. Maria loved to swim, and while other girls her age played with Barbie dolls, Maria fantasized about being a mermaid. She would spend hours in the huge claw-footed bathtub in their old Victorian house, contentedly splashing around in flippers. In 1989, Howard moved them to an abandoned beach cottage in southeastern Massachusetts that was surrounded by water and marshland. The cottage sat right on the edge of a tidal marsh, where the Nasketucket River emptied into the bay. Howard fervently hoped that being lapped by water might calm Maria's inner demons.

  It didn't work. Shortly before her twelfth birthday, Maria's emotional state worsened. She was by turns agitated and full of restless energy and then severely lethargic and depressed. She talked of killing herself. And there were rages, when Maria would spiral out of control over the smallest things. She often ran outside to escape the voices in her head, taking long walks on the beach with her dog, exhausting herself against the roar of the wind and the waves. On several occasions she had run outside in the middle of winter in her pajamas, and Howard had been forced to call the police. Another time, Maria attacked one of the Windsor dining room chairs that Howard had inherited from her grandmother. Even though Maria weighed less than eighty pounds, she had grabbed the wooden spokes in the chair and torn them out. Howard had to call the police again because she feared for Maria's safety. By the time the police arrived at the isolated cottage, the chair was a pile of toothpicks on the floor and Maria was sitting next to it, looking dazed.

  Over the years, Howard came to know the local police quite well. She also dragged Maria to one expert after another-psychologists, a neurologist at Massachusetts General Hospital, a psychiatrist at Children's Hospital, a learning specialist, more psychiatrists. Maria had been hospitalized several times and prescribed all manner of psychoactive medicine. Along the way, she had collected twenty-seven different diagnoses. Post-traumatic stress disorder, depression, oppositional defiant disorder, attention deficit disorder, borderline personality disorder, psychosis undifferentiated, schizophrenia-the list went on and on.

  The summer that Maria ripped the thermostat out of the wall, she was seeing a child psychologist and a child psychiatrist who worked together in New Bedford. The psychiatrist had recently prescribed Prozac, a new antidepressant that was getting rave reviews. If anything, though, the drug seemed to make Maria more agitated and violent. As Howard sat at the kitchen table that Saturday morning, she stared hard at the hole in the wall where the thermostat had been, as if it would somehow yield a clue to the mystery that was Maria.

  A FEW WEEKS LATER, Howard finally wangled a fifteenminute consultation with Maria's psychiatrist. His practice was on the first floor of an elegantly appointed historic mansion that he owned in downtown New Bedford.

  When Howard told the psychiatrist about the incident with the thermostat, she noticed that he quickly glanced around his office, which was filled with expensive furniture and valuable antiques.

  "I'm not going to be able to treat your daughter anymore," he said. "I don't think she's treatable."

  He then advised Howard to terminate the adoption, return Maria to the custody of the state, and "cut your losses." Howard sat glued to her seat in shock.

  It was now the first week of September. School was about to start, and Howard was feeling desperate. Maria wouldn't listen to her, and if she so much as looked her way, the girl would fly into a rage. Howard couldn't stand the thought of another year of expulsions, hospitalizations, threats, and tears. Swallowing her pride, she called the psychologist who worked with Maria's psychiatrist even though this woman too had said Maria was untreatable. But Howard had to find a new psychiatrist. Did the psychologist know of anyone?

  "As a matter of fact, a new psychiatrist has just joined the practice," the woman said. "He says he would be willing to see Maria."

  Howard would remember the psychologist's exact words more than a decade later. It was the first time she heard of the doctor whose clinical skills and diligent care would help her daughter begin the long road to recovery.

  Four days later, Howard returned to the historic mansion near New Bedford's waterfront. The new psychiatrist's office was in the back of the building, a modest room cluttered with boxes of unpacked books. He looked young to Howard but seemed soft-spoken and earnest. He listened intently as Howard poured out the story of her daughter's bizarre behavior. He asked a few questions, and then he put down his notes and leaned forward in his chair.

  "Your daughter has bipolar disorder," he said quietly. "Here's what we're going to do ..."

  arty Teicher leaned forward, riveted by the elegantly dressed woman standing behind the microphone. Her name was Mrs. Frederic Richardson, and she was the twenty-second speaker that morning to address the FDA's Psychopharmacological Drugs Advisory Committee. The blue-ribbon committee had been convened on September 21, 1991, in response to rising public concern over claims that Prozac caused some people to become suicidal and even violent. Thus far, the FDA had fielded at least fourteen thousand reports of patients who had experienced adverse effects from taking the drug-a far higher rate of complaint than with any other medication to date. The Public Citizen Health Research Group, a Washington, D.C., watchdog organization, had recently filed a petition asking the FDA to put a new warning on the Prozac label about the heightened risk of suicidal behavior. The Church of Scientology had also launched a massive public relations blitz against the drug. The Scientologists' campaign, however, seemed to be having a paradoxical effect: it was rallying psychiatrists and the mainstream press in defense of Prozac. In fact, just a few months earlier, Time magazine had run a cover story attacking the Church of Scientology as a power-hungry cult. The magazine quoted a cult expert as saying, "Scientology is quite likely the most ruthless, the most classically terroristic, the most litigious and the most lucrative cult the country has ever seen." Among Teicher's colleagues at Harvard and McLean, emotions were running high. At the annual meeting of the American Psychiatric Association that year, Teicher overheard someone refer to him as "that Scientologist from Massachusetts."

  Even so, the FDA had invited him-Marty Teicher from Plainview, Long Island-to act as one of the six expert consultants for this unprecedented public hearing in Rockville, Maryland. Tei
cher knew he had been summoned because of his paper on Prozac. Ever since the article, titled "Emergence of Intense Suicidal Preoccupation during Fluoxetine [the generic name for Prozac] Treatment," had been published in the American Journal of Psychiatry in February 1990, he had received hundreds of letters from people around the world, many of them from family members whose loved ones had killed themselves or tried to while taking Prozac. His office had also fielded dozens of calls from attorneys who were interested in suing Eli Lilly, the manufacturer of Prozac. Teicher had refused to take their calls, but several attorneys had told his assistant Cindy McGreenery that they were psychiatrists who needed Teicher's advice with a patient. He had returned their calls only to find himself connected to a law office, at which point he promptly hung up.

  One afternoon a few weeks after the paper's publication, his intercom buzzed. Cindy told him that a psychiatrist from Washington, D.C., was on the line, asking to speak to him about a patient. Did Marty want to take the call?

  Teicher ran his hand through his combed-back hair. He felt torn. What if this was yet another attorney pretending to be a colleague? He didn't want to be dragged into legal fisticuffs with Lilly. Yet he was beginning to enjoy his new status as a sought-after expert on the subject of Prozac. There was a part of him that relished playing the role of a latter-day David to Eli Lilly's Goliath. The more some of his colleagues warned him to back off-it wouldn't be good for his career, they said-the more he wanted to run full tilt at the issue of whether Prozac caused suicidal thoughts and behaviors in certain patients. Teicher had always liked the feeling of living life on the edge, passionately engaged. In college he'd been able to pull it off. A top student, he'd also had a regular radio show, had played in his own band, and was constantly going off to late-night concerts, all the while keeping his grades high enough for graduate school.