Which God Do I Obey?

Which God Do I Obey?

In light of the recent New England Journal of Medicine article detailing the intentional decision by Big Pharma to mislead medical doctors and the public as to the effectiveness of anti-depressants like Lexapro and Paxil, what is the duty of doctors, scientists and employees of these companies to the God of Truth? Is it to ignore the fact that 96% of the unpublished studies on these dangerous drugs showed that they had little or even no effectiveness?

If a doctor or the public knew that the scientific evidence was not clear that these harmful drugs were not effective, this would surely have caused many doctors not to prescribe them. Had there been full disclosure, many lives would be saved—among those some of the students who were fired upon by their fellow students or others on these same anti-depressants.


A U-boat captain in WW I prior to becoming a pastor, Pastor Niemoller refused to follow the Nazi line and Hitler had him sent to the Sachsenhausen and Dachau concentration camps where he remained until the end of the war. After his release in 1945, he penned these words:

In Germany they first came for the Communists, and I didn't speak up because I wasn't a Communist.

Then they came for the trade unionists, and I didn't speak up because I wasn't a trade unionist.

Then they came for the Jews, and I didn't speak up because I wasn't a Jew.

Then they came for the Catholics, and I didn't speak up because I was a Protestant.

Then they came for me — and by that time no one was left to speak up.


David S. Egilman, MD is Clinical Associate Professor at Brown University’s Department of Community Health. He was associated with litigation against Eli Lilly and Zyprexa, the drug whose $4.2 billion in sales made up 30% of Lilly’s total sales in 2005. Dr. Egilman saw some documents that, according to articles in the New York Times, revealed:

  • Zyprexa has a tendency to raise blood sugar and to promote obesity, both of which are risk factors for diabetes.
  • Some 30 percent of the patients taking Zyprexa gain 22 pounds or more after a year on the drug, with some gaining 100 pounds or more. Yet the documents show that Lilly encouraged its sales representatives to play down these adverse effects when talking to doctors.
  • Lilly encouraged primary care physicians to prescribe the drug for older patients with symptoms of dementia even though it was approved only for schizophrenia and bipolar disorder. It is illegal for companies to promote drugs for unapproved uses, but nearly every major drug company is under civil or criminal investigation for alleged efforts to do so.
  • For at least a year, Lilly provided information to doctors about the blood-sugar risks of its drug Zyprexa that did not match data that the company circulated internally when it first reviewed its clinical trial results, according to company documents.
  • A February 2000 memo sent to top Lilly scientists showed that patients on Zyprexa were 3.5 times as likely to experience high blood sugar levels as those taking a placebo.
  • Despite another 1999 report on the results of 70 clinical trials that 16 percent of patients taking Zyprexa for a year gained more than 66 pounds, Lilly did not publicly disclose this but instead provided data from a smaller group of clinical trials that showed about 30 percent of patients gained 22 pounds.

Lilly was successful in getting the court to seal the documents provided to Dr. Egilman during discovery to prevent the public from ever knowing the truth about this dangerous drug.

Dr. Egilman is alleged to have conspired with a New York Times reporter to get around the court order by having another attorney subpoena the reports and that attorney released them to the reporter. Dr. Egilman was attacked by the court and Lilly. Here is an article written by Dr. Egilman.


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.


Eli Lilly has now paid out more than $1.2 billion in settlements to people who contracted diabetes or suffered other serious health problems while taking Zyprexa, or to their families if these victims died. Presently, over 30 states have filed actions against Lilly because of the false and misleading claims about Zyprexa and there are approximately 6,000 more unsettled personal suits against Lilly and Zyprexa.

Some say that Dr. Egilman chose to not obey the God of the law when he “arranged” for the documents showing the true data about Zyprexa to be released. Dr. Egilman, like Pastor Neimoller, chose to obey a different God—the God of truth. For this act both men have paid—Dr. Egilman only in money, but paid nonetheless.

How many lives did Pastor Neimoller save by speaking out? How many were able to escape Germany because Pastor Neimoller warned them about Hitler? How many lives will Dr. Egilman save by choosing the God of truth and warning all of us about Zyprexa?

Perhaps the more troubling question is how do the Eli Lilly scientists and executives who worship the God of profit sleep at night? As they look out the windows of their huge homes acquired with profits from drugs that harm and kill, my guess is not very well. I certainly hope that is true and that more of them wake up and act like Dr.Egilman when they choose the God to obey.

I am contacting Dr. Egilman and offering to make a contribution to the payment of his $100,000 fine. I hope you consider doing the same.

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