The depressed Joseph Wesbecker probably didn't have the slightest inkling that he would set off a nearly decade-long legal battle to shape the legal identity of Prozac. Armed with an AK-47 assault rifle and four other weapons, he entered the premises of his former employer, Standard Gravure Corp. in September 1989, and proceeded to kill eight people and wound 12 others, in what was later described as a vengeful rage. Wesbecker took his secrets to the grave by then killing himself with a 9mm pistol.
Five years later, 28 plaintiffs, including survivors and victims' heirs, squared off against Eli Lilly in a product liability trial (Fentress, et al. v. Shea Communications, et al. Jefferson Circuit Court, No. 90-CI-06033), that alleged Wesbecker was driven to his murderous rampage by ingesting physician-prescribed Prozac. Seeking $50 million in compensatory and punitive damages, the lawsuit claimed that the drug manufacturer concealed Prozac's propensity to cause violent and aggressive behavior and that it marketed the drug without proper testing or warnings.
The case spawned national headlines, and the stakes were huge. Waiting in the wings were another 160 lawsuits and the threat that an adverse result could drastically reduce the revenues Lilly generated from the drug. During 1993, the year immediately preceding the trial, Prozac brought in $1.7 billion.
When after a 47-day trial that lasted into mid-December 1994, the jury returned a 9-3 verdict exonerating Eli Lilly from any responsibility the company breathed a very public sigh of relief. "The members of the jury . . . came to the only logical conclusion: that Prozac had nothing to do with Joseph Wesbecker's actions in September 1989," proclaimed Randall L. Tobias, Eli Lilly's chairman and chief executive officer.
Maybe it didn't, but Lilly decided not to take any chances. Unknown to anyone, including presiding Judge John Potter, the parties had secretly settled significant aspects of the case before it went to the jury, raising concerns that the parties had illegally or unethically manipulated the court proceedings.
By April 1995, Judge Potter had learned enough about the alleged maneuvers to schedule a hearing for any party to show cause why the judgment should not be amended to read "dismissed with prejudice as settled," a change that would have erased Lilly's hard-won victory with the stroke of a pen. Irked by the appearance that he had been sandbagged into letting a case that had already settled go to the jury, Judge Potter issued broad ranging subpoenas in an attempt to uncover the terms of the settlement. The plaintiffs and defendants responded with pleadings of their own, seeking a writ of prohibition enjoining Potters' inquiry.
Initially victorious at the court of appeals level, the parties were dealt a stinging defeat after Judge Potter petitioned the Kentucky Supreme Court, Potter v. Eli Lilly and Company, et al., 926 S.W.2d 449 (1996). Ruling that Judge Potter had inherent authority to investigate potential misconduct, a unanimous court wrote, "In this case, there was a serious lack of candor with the trial court and there may have been deception, bad faith conduct, abuse of the judicial process or perhaps even fraud."
Details later emerged of, among other things, the parties' agreement to withhold evidence of Eli Lilly misconduct in connection with the arthritis drug Oraflex. But the year's long investigation ended with the legal equivalent of a whimper, when on January 5, 1998, circuit Judge Edwin Schoering ruled, "no further proceeding in this matter is necessary and the corrected judgment entered March 24, 1997, terminates this litigation." He ignored the controversy over the Oraflex evidence entirely, thus leaving it to legal commentators to speculate about what would have happened had the jury been told.
Said Richard Hay, a Somerset, Ky. attorney who represented Judge Potter, Eli Lilly's settlement ploy was "a way for a big corporation to pull the wool over the justice system's eyes." Nevertheless, he denies that Eli Lilly's strategy succeeded. "At least the attempt to fool the American public and particularly other plaintiffs in the Prozac cases, that didn't work."
Maybe so, but since Fentress, the number of cases against drug companies has noticeably dwindled. For instance, Lilly is currently fielding less than 20 civil cases involving Prozac, while Pharmacia & Upjohn, Inc., makers of the sleep preparation Halcyon, has seen suits wither to "a handful" after defending about 100 cases in the early 1990s. With the heyday of these lawsuits over, what remains nevertheless is a continued stream of criminal defendants who claim that their misconduct was the result of physician-prescribed psychotropic medications.
Trouble in Paradise
The notion of antidepressant induced tragedy caught fire in late 1990 with the suggestion in psychiatric literature by Harvard Medical School's Martin Teicher, M.D. that Prozac was implicated in violent suicidal preoccupations of several patients (Am Jl Psychiatry 147: 20 7-10 Feb 1990). Timing and the nonprofit conglomerate Church of Scientology created a public relations nightmare for Eli Lilly, then enjoying a wave of popularity that had already transformed Prozac into a phenomenon. Patients stopped treatment, some killing themselves as an unfortunate result, and concerns generalized to other antidepressants in the selective serotonergic (SSRI) family, and even other psychotropics. It wasn't long before concerns over Prozac expanded to the criminal defense arena, with defenses against violent crime referring to Prozac treatment repeatedly raised. Eli Lilly assisted the prosecution repeatedly in these cases, hoping to mitigate decisions that would cast aspersions on its product.
Since Fentress, the number of cases against drug companies has dwindled.
SSRIs (selective serotonin reuptake inhibitors)
- fluoxetine (Prozac)
- paroxetine (Paxil)
- sertraline (Zoloft)
- fluvoxamine (Luvox)
The full court press legal strategy of Eli Lilly had much to do with quashing the trend and saving the profile of the most successful antidepressant drug ever.
In Florida, for instance, an appellate court reversed the first-degree murder and kidnapping conviction of then 16-year-old Victor Brancaccio, who beat an innocent pedestrian to death while on a walk "to cool down" following an argument with his mother. Later he unsuccessfully attempted to burn the body and then spray painted it in an effort to conceal his fingerprints. The defendant presented expert testimony that he was involuntarily intoxicated by sertraline (Zoloft), but the trial judge had refused to instruct the jury on this theory; Brancaccio was convicted of murder.
In Brancaccio v. State of Florida, 698 So.2d 597 (Fla. App. 4 Dist. 1997), the appeals court saw the case differently. Defense experts Wade C. Myers, M.D., a Gainesville, Fla. psychiatrist, and Peter R. Breggin, M.D., a Bethesda, Md. psychiatrist with a long record of strident opposition to biological psychiatry, testified that Brancaccio's conduct was the result of mental incapacity induced by sertraline. The court reversed the conviction, ruling that the involuntary intoxication instruction should have been given, and remanded for a new trial. It cited a 1992 case involving Prozac and Xanax (Boswell v. State, 6l0 So.2d 670). In Boswell, a defendant with cirrhosis of the liver (which limits metabolism of the drug) who had high levels of Prozac in his system when he shot a police officer, was allowed to present an involuntary intoxication defense that he hallucinated a shot, which prompted his actions—based on its impression that Prozac can cause hallucinations (quite a rare phenomenon). This argument influenced the Brancaccio court, which heard testimony of the similarities between Prozac and Zoloft.
Do the SSRIs cause violence? Since the early 1990s, a range of opinions has evolved among psychiatrists, based on their experience with patients and review of published literature primarily refuting the Teicher group's findings. Combined with the intrusion of hired gun testimony, attorneys on both sides of the aisle have the opportunity to shop for supporting viewpoints.
William C. Wirshing, M.D., professor of psychiatry at the University of California, Los Angeles, School of Medicine, was one of Lilly's "silent consultants" during the legal fallout after the Wesbecker shooting. In total, he also provided advice in nearly 100 cases involving Prozac, working with plaintiffs and the defense. "Do these molecules cause violent behaviors that otherwise wouldn't be present? The answer is that with the data we have now, no," he asserted. But Dr. Wirshing conceded to The Echo, "That doesn't alter the fact occasionally they are associated with violent outcomes to self or directed to others and it makes one wonder whether individual effects occur." A less prevalent view among prescribers holds that psychiatric medications definitely induce people to commit criminal or suicidal acts.
Some charge pharmaceutical companies with hiding the information about cases when suits following violent behavior have been settled. Indeed, Talarico v. Dunlap, 685 N.E.2d 325 (Ill. 1997), reviewed in this month's Echo, settled a charge of Accutane-related violence, but Roche Pharmaceuticals does not include this case when asked about cases of aggression, violence, or arrests while on this medicine. Jonathan O. Cole, M.D., a professor of psychiatry at Harvard Medical School, and a coauthor of Dr. Teicher's work linking Prozac with suicide, didn't mince words when it came to Lilly's portrayal of the suicide risk of the medicine.
"The incidence of attempted or consummated suicide in depressed patients is rare, but the incidence of attempted and consummated suicide is significantly greater in patients on Prozac than in patients on other anti-depressant medication," Cole wrote in an expert opinion prepared for court. He added that Lilly knew about the "telltale signs and symptoms" of a reaction to Prozac, but that "Lilly failed to adequately notify the FDA or warn the community of them."
David J. Greenblatt, M.D., Chair of the Department of Pharmacology at Tufts University School of Medicine in Medford, Massachusetts, calls these kinds of charges "absurd." Dr. Greenblatt, significantly involved in controversies surrounding the anti-anxiety medicine Triazolam said that "there's not one shred of scientific evidence to support that."
SSRIs in rare instances may cause the unrelated serotonergic syndrome. The serotonergic syndrome is a dramatic change in mental status that includes frank confusion, disorientation (Lane R, Baldwin D, Jl Clin Psychopharm 1 7:20&21 Jun 1997) and agitation, among other things. Even the "herbal" St. John's Wort, whose effects are in part linked to serotonin activity, has been reported to cause this alarming reaction. These are the most legitimate scenarios to date of antidepressants inducing states which can alter thinking to the point of legal insanity in jurisdictions with the M'Naghten standard or its derivatives.
But the door to involuntary intoxication remains open. Last year, in another case, a 25-year-old Virginia man was acquitted of charges he assaulted a police officer after testimony that a combination of seven psychiatric medications induced an "intoxication that would have impaired anyone's mental capacities." According to William Hassan, the Fairfax, Virginia based attorney who defended the case, Commonwealth v. Amanulla Khaliqi, records showed that his client was prescribed an array of medications that included haloperidol (Haldol), lorazepam (Ativan), valproic acid (Depakote), clomipramine (Anafranil), risperidone (Risperdal), and alprazolam (Xanax). Though allegedly suffering bipolar disorder, schizophrenia and schizoaffective disorder, "it was our view that the defendant would not meet the insanity tests in Virginia, but for the drugs," Hassan told The Echo.
The door to involuntary intoxication is open.
And some of these drugs have relevant side effects. Both Haloperidol, and to a lesser extent Risperidone, are known to cause akathisia, a movement disorder associated with violence.
Akathisia and Violence
Haloperidol, a medicine prescribed for psychosis, has been found to be more active in the nigrostriatal areas of the brain. The nigrostriatal activity is thought to influence the movement disorder known as akathisia. People with akathisia feel they cannot sit still, and are often seen to fidget and pace with uncomfortable pent-up energy. Akathisia has been linked to violence (Crowner ML et al. Psycho-pharm Bulletin 26:115-117 1990). Risperidone, while less active in the nigrostriatal region, has also been known to cause akathisia. And akathisia has been distinguished from anxiety ratings in research completed by Australian research (Sachdev, P Archives of General Psychiatry 5l:pp. 963-974 Dec 1994), so it is not merely anxiety and tension that irritate the akathisia sufferer.
Making the leap from medication induced akathisia to lacking appreciation of wrong, or the nature or consequences of actions, is difficult. Akathisia, while quite uncomfortable, is no different a mitigating factor than chronic pain or caffeine intoxication. And with akathisia distinguished from anxiety, it may be more difficult to establish it as an extreme emotional disturbance.
Is akathisia the reason behind behavior problems associated with SSRIs? Several investigators have attributed the potential for causing akathisia to SSRIs (Rothschild AJ, Locke CA. Jl Clin Psychiatry 52:pp. 491-3 Dec 1991; Hamilton MS, Opler LA Jl Clin Psychiatry 53: pp. 401-6 Nov 1992).
Roy Black, a Miami, Florida attorney remembered for his famous clients Michael Kennedy Smith and Mary Albert, is scheduled to retry Brancaccio this year. "I think the mental illness issue is stronger, because when you look at [drugs such as] Prozac or Zoloft, the overwhelming amount of people who use them have a beneficial result," acknowledged Black. "There are some people who have adverse side effects, but we don't really need to blame the drug."
Those Damn GABA Receptors
The roots of involuntary intoxication reside in unexpected intense behavior changes on alcohol. Voluntary alcohol intoxication has consistently been disregarded as a basis for an insanity defense (see U.S. v. Garcia, NYLJ 8/2/96 PU; The Forensic Echo, 1:1 p. 6 Nov 96). A very small number of people, however, may develop dramatic behavioral changes and an altered sense of reality after ingesting only a very small amount of alcohol.
Idiosyncratic Alcohol Intoxication—Does It Mean Underling Intermittent Explosive Disorder?
There has been enough debate about idiosyncratic intoxication that it has not been listed as a psychiatric diagnosis in the most recent version of the psychiatric diagnosis manual DSM IV (Kaplan H, and Sadock B. Synopsis of Psychiatry 1994 Williams and Wilkins pp. 404). This condition, however has been described in a number of settings. Exquisite sensitivity to the effects of alcohol has been linked to intermittent explosive disorder, also known as episodic dyscontrol disorder, a condition also noted for the explosive, incendiary violence seen. Those with this condition, like the idiosyncratic alcohol intoxicated, have no later recall for their actions, and voice great regret (Bach-Y-Rita G, Lion JL. AMJL of Psych 127: pp. 49-54 1971). They often have temporal lobe abnormalities on EEG. And CT and MRI findings may show anterior-inferior changes in the temporal lobe (Journal of Neuropsychiatry 3-2 pp. 189-96 1991).
Intermittent explosive disorder has been successfully presented as an insanity defense; the degree of disorientation is so great, sometimes including primitive behaviors of biting and clawing, that those with the condition might not even understand the nature and consequences of their actions. The best clue to this possibility remains a particularly grisly or uncontrollable attack with very mild if any premeditation. The defendant's amnesia may not be able to provide a history of alcohol ingestion prior to the attack, but a history may exist of previous similar responses to alcohol.
One of the most popular classes of medicines to treat anxiety remains the sedative hypnotics, so called because they traditionally calm at lower doses and cause sleep at higher doses. The sedative hypnotics include benzodiazepines and the less commonly prescribed barbiturates. They exert their effects by acting on gamma-aminobutyric acid (GABA) receptors scattered throughout the brain—as does alcohol.
Is akathisia behind the SSRI controversy?
An unusual phenomenon of paradoxical agitation has been described in some of the patients prescribed these GABA acting medicines for panic or anxiety. Complicating this presentation is the history that the patient has been prescribed the medicine for agitation in the first place. The prescribing physician may, and rightly so, increase the dose of the sedative, thinking he has not yet dosed the patient sufficiently—and the patient's behavior becomes more and more agitated. In one particularly dramatic incident, a patient shattered his hospital window with a chair, then assaulted nurse's aides who attempted to restrain him from jumping out that window. With a change in medicines, he was calm by the end of the day, and remembered nothing of the incident.
Medicines with GABA Activity in the Brain That Have Been Implicated in Unexpectedly Violent Behavior
Behavior that results from suppressing the impulse controlling abilities of the frontal lobe. This is one of the most important contributors to the behavioral changes of alcohol intoxication, from sociability to making passes to wearing lampshades at Christmas parties to responding to provocation violently. Disinhibition is not the person's typical behavior; but the actor retains the ability to appreciate the nature and consequences and right from wrong.
Benzodiazepines, which act throughout the brain and may affect alertness, have been raised in criminal defenses (see State v. Williams, 44 Conn. App. 231 (1997); The Forensic Echo, 1:8p. l8 June 1997). The peculiar behaviors linked to benzodiazepines have ranged from rage reactions to frank disorientation to disinhibition. How common is this phenomenon?
In a review of case reports and experimental findings, Dietch and Jennings (Jl Clin Psychiatry 49: pp. 184-88 May 1988) estimated the incidence of bizarre reactions to benzodiazepines at approximately 1%. The authors described clonazepam as more associated with aggressive reactions, primarily in children who take it for seizure disorders. Alprazolam was described as having a more common incidence of idiosyncratic effects, particularly in those with borderline personality disorder, a history of strange reactions to medicines, and—surprise—idiosyncratic reaction to alcohol (Gardner Ri Cowdry RW Am Jl Psychiatry 142:98-100 1985). Reactions to GABA acting drugs where behavior becomes truly wildly uncontrollable must be distinguished from mere disinhibition, where impulse overcomes self-control.
Easier Said Than Done
A careful analysis of the events leading up to the crime, the behavior involved, timing of ingestion, and integrating expected timing of drug metabolism, as well as a comparison with past behavior and medicine ingestion patterns, may provide a history of frank disorientation which is much more consistent with a lack of appreciation of nature and consequences or of wrong. In this manner, an intoxication defense can be developed with scientific legitimacy. The gravity of the moment-to-moment analysis of behavior preceding a crime therefore demands that the forensic psychiatrist or psychologist ask about pills or substances in the day before the crime, and amounts and rate of ingestion, as well as motive for ingestion.
This approach sounds fairly simple. But in 1996, New Yorkers learned that intoxication defenses are no cinch when Edward Leary was convicted of murder after a subway firebombing incident. Mr. Leary, unemployed and dispirited, walked onto the #4 train reeking of gasoline that unexpectedly ignited, averting a far greater tragedy. At that time, he was treated with a pharmacological cocktail that included Prozac, Effexor (venlafaxine), and Buspirone (Buspar), the latter two drugs (with prominent serotonergic activity) relative newcomers to the legal microscope. Despite supporting testimony from a psychiatrist with a history of primarily prosecution work, Leary's bid for an insanity defense failed. Reflecting the unapologetic confidence Eli Lilly has in the safety of its product, a prosecution psychiatrist responded to the question, "Did you know that Prozac is a one billion dollar a year business?" with, "As well it should be."
Antidepressant induced agitation is described for each of the multitude of drugs available. Serotonin, the deified neurochemical responsible for treating anxiety, depression, and the agitation of many patients, is mysteriously implicated in these paradoxical behavior changes. But this irritability, which does not traditionally override self-control, is seen in Bupropion as well, a medicine not thought to have a major serotonergic activity. And increased agitation in those treated with the older tricyclic antidepressants, which act primarily on the noradrenergic system, and MAO inhibitors has been long acknowledged. As with akathisia, however, this irritability while rendering a person more vulnerable to provocation, does not leave a person devoid of a sense of right and wrong—unless the medicine causes a manic episode.
Antidepressants, more frequently the tricyclics, have also been known to precipitate hypomania. Hypomania, more than mild irritability, causes a person to demonstrate pathologic agitation. Mania, where the person may lose contact with reality, can also result in some antidepressant treatment. Highly sensitive to surroundings as manics can be, a person suffering this condition can act without an appreciation of the nature, consequences, or of wrong. However, the mania associated with antidepressants is less likely associated with delusions or hallucinations (Stoll AL, Mayer PV Am Jl Psych 151:1 642-5 Nov 1994), a virtual necessity for many insanity defenses.
In spite of the occasional untoward reaction, psychiatrists endorse the safety of the aforementioned drugs by continuing to prescribe them even minutes after signing the checks on their malpractice insurance premiums. Perhaps that is the strongest endorsement of all. But the wounds of the all out Breggin-Church of Scientology war against psychotropic drugs cut deep. Psychopharmacologists routinely advise their patients to inform them about any upsurge of aggressive impulses or behavior. Some prescribers prefer medicines with more sedating qualities in patients with a history of violence just to be on the safe side.
Tomorrow's More Potent Drug Defense
The next wave of defenses may couple the uncertainty of the antidepressants with the certainty of illicit drugs. The violence inducing effects of cocaine, PCP, and alcohol are well established. But SSRIs may delay the metabolism of alcohol; patients often report unexpected feelings of intoxication after only a drink or two. Surprise intoxication has also been described with benzodiazepines such as flunitrazepam (see Rapist in a Glass, The Forensic Echo 1:10 pp. 4-10 Oct. 1997). This factor represents the most intriguing battleground yet to emerge in this area, and reflect trends within psychiatry for identifying potential drug interactions.
Front-line psychopharmacology has become increasingly preoccupied with which enzymes in the liver metabolize which psychiatric drugs. We can identify beyond the theoretical level, those medicines more likely to prevent an illicit drug from getting out of the system, amplifying its toxic behavioral effects, even if that drug doesn't itself cause violence.
Alcohol has been linked to the p450 2E1 system. Effects of other drugs on this enzyme system are yet to be established.
This process is the legitimate defense argument to be made in the involuntary intoxication issue in Boswell and other cases to come. And if successful civil litigation follows, we may yet see package warnings advising patients just why they must not combine their medicine with alcohol or other illicit drugs.
Drug interactions are the future of the drug defense.
The Drug Interaction—Criminal Responsibility Link
Even if a person willingly ingested a substance, did that person know that he was ingesting a substance at an amount that would cause behavioral effects? Some defendants will legitimately report they had taken that amount of cocaine, or consumed that quantity of alcohol before, without showing any violent criminal behavior. But if after that a person were prescribed a medicine that, unbeknownst to him, interferes his body's ability to rid his body of that drug, and he becomes violent as a result, is that not an intoxication?
Any drug taken by mouth must be absorbed into the system to have effects in the first place; otherwise, it just passes in a bowel movement. Medicines that increase absorption of ingested pills from the gut can amplify the effects of these drugs.
Once absorbed, some of the drug binds to proteins in the bloodstream, while some of the drug runs free. But other medicines may bind to proteins in the bloodstream too; and if this happens, too much of the medicine remains free in the system to exert its full effects.
The cytochrome p450 enzyme system in the liver is responsible for helping to break down and help the body rid itself of the overwhelming majority of medicines and drugs we ingest. This is why liver disease is poisonous to the human body. When one's capacity to digest these drugs breaks down, the toxic effects of the medicines affect other parts of the body—including, in some cases, the brain.
But liver damage isn't the only way this happens. Sometimes medicines inhibit the same p450 enzymes needed to break down certain drugs; this may be enough to significantly elevate the concentration of sedatives, or alcohol, or other drugs, in the bloodstream—and contribute to toxic behavior effects.
The p450 systems most pertinent to today's intoxication cases are p450 3A3 and 3A4. These are systems inhibited by Prozac and Luvs that would otherwise break down the sedatives XENIX and Halcion. This is how intoxication with these sedatives can occur when the antidepressants are prescribed. Lowering the doses of Prozac typically obviates this risk.
So Your Defendant Was Prescribed a Medication. What Do You Do?
- Establish what dose he has been taking.
- Any increases or decreases in the dose lately?
- Any other drugs taken for medical problems?
- Inventory exactly what drugs, how much of them, and the timing of ingestion relative to the offense.
- What was the reason for ingesting any drug or substance not regularly taken or prescribed?
- How do the drugs he takes traditionally affect him?
- Any medical problems lately?
- Did he note any behavioral changes prior to the offense?
- Does he remember the offense?
- What do witnesses describe about his behavior relative to its usual quality?
- Get a urine tox screen as close to a 24 hour window within the time of arrest as possible, no matter what: while drugs do not negate criminal responsibility, the influence of drugs on an underlying psychiatric condition, or the possibility of a drug interaction that contributed to the offense, can be better supported or refuted with test results.
Future directions of psychopharmacological progress in the court will be driven by genetic research that shows sensitivity to pathological intoxicating effects of medicines. One example of this is seen in Japanese studies that identified chromosome correlates of significantly elevated blood pressure in response to alcohol ingestion (Blood Press 6: pp. 112-116 Mar 1997).
When Forsyth, etc. et al. v. Eli Lilly and Company, Civil No. 95-00185 goes to trial in June in a Hawaii federal district court, the safety of Prozac will again be put to the test. In a case reminiscent of Fentress, the pharmaceutical company will defend itself against charges that the antidepressant caused William Forsyth to murder his wife by stabbing her 15 times, then to kill himself with the same knife. Unlike Joseph Wesbecker, however, William Forsyth never exhibited any homicidal or suicidal proclivities.
In an unusual twist, Lilly argued in a motion for summary judgment seeking to end the case—an effort that substantially failed—that Prozac is an "unavoidably unsafe product," a characterization that would negate its liability for harm so long as adequate warnings were provided. But the court ruled that "there is a genuine issue of fact as to whether Lilly provided adequate warning for Prozac."
Meanwhile, the plaintiffs have lined up a number of experts to support their view that the violent end of Mr. and Mrs. Forsyth was caused by Prozac. According to one of them, David Healy, M.D., "the profile of the case fits very closely with the profile of Prozac-induced violence eventuating in suicide or homicide that has been outlined by a number of experts in the field." Expressing his viewpoint in a court filing, Healy added that, "contrary to Lilly's view, there is a plausible cause and effect relationship between Prozac and such events." Eli Lilly has denied that there is such a relationship.
This is the last of 13 cases brought by Los Angeles attorney William Downey, III. He is not allowed to comment on what happened to the other 12, except to say that they are no longer pending, leaving the prospect that they were settled open to speculation. It's still too early to tell, therefore, whether a verdict in Forsyth will ever be handed down, or whether it will just disappear like all the rest.
Silence makes frivolous lawsuits infrequent, but is there something to hide?
Reluctant to encourage publicity that may instigate more lawsuits, all the makers of psychiatric medications contacted for this article either declined to comment or failed to return repeated phone calls. But this isn't just limited to the companies; litigation fearful psychopharmacologists have closed ranks to keep the discussions of violence behind close doors.
It's out there, seldom seen, but the monster does not live in the Loch Ness. While manufacturer and physician silence keeps the medicines off the front page, minimizes hysterical misinterpretation, and therefore limits frivolous civil litigation, the law community has reason to wonder exactly what the public hasn't been told about the causal link between medicine and violent tragedy. Unless there really is something to hide, this mystery will maintain an opening for the defendant to run to daylight.
