Books: Hopping mad on happy pills

Julia Neuberger is dismayed by the outcome of an American Prozac trial

The Power to Harm: Mind, Medicine and Murder on Trial by John Cornwell, Viking, pounds 18

Prozac is very much within the new pharmacopoeia for depression and any story about it is guaranteed to attract a lot of attention. You'd think that would be particularly true when there is a major court case in the US, alleging that Prozac was at least partly responsible for the change of personality in someone who committed suicide after firing rounds of bullets into his work colleagues. But the timing, from the point of view of Eli Lilly, the Louisville manufacturers of Prozac, was impeccable: the case went to court at the same time as the O.J. Simpson trial and the goings-on in Kentucky were largely ignored.

They shouldn't have been. On 14 September 1989, Joseph Wesbecker entered the printing plant he had worked in for years, with an AK-47 automatic gun and shot 20 of his colleagues before turning the gun on himself. Wesbecker had been on long-term disability leave from the company as a result of mental illness and had been taunted by his workmates.

The nub of this story is: was Wesbecker just a bad guy, fully in control of his actions, or did he not know what he was doing because he was mentally ill? If he was mentally ill, had his disability been caused by an inherited illness that was exacerbated by difficult circumstances in his early and later life? Or was it because Prozac had heightened his aggressive behavioural patterns?

We do not know what causes spree killings. The explanation that someone is not responsible for their actions because of the circumstances of their early life, or multiple personality, or some other form of personality disorder, is well attested in American law. It is also clearly an issue at the heart of psychological and neuroscientific research.But whatever we think becomes shockingly irrelevant in this case because of the way the plaintiffs' lawyers and the Eli Lilly lawyers settled in secret before the trial finished - without telling Judge Potter, the trial judge.

As Cornwell's book went to press in May, the Supreme Court declared that Judge Potter could conduct a hearing to determine whether the plaintiffs and Eli Lilly had misled the court about a pre-verdict agreement. Cornwell quotes Ed West of Eli Lilly, who argued that even if the verdict eventually went to a settlement rather than a finding that cleared Prozac of any blame "it shouldn't in any way reflect negatively on the product...it's a question of legal procedural wrangling."

Not so. It is fundamental. The plaintiffs' lawyer has given up all his other actions for those claiming Prozac has damaged them or their families. They are now considering suing him for betraying their interests. And he has betrayed their interests. For we have still not tested out how much of a contributory factor Prozac was in Wesbecker's behaviour.

Nor has the conduct of some of the clinical trials been satisfactorily examined in court, even though they were raised during these hearings precisely because of the desire to settle. The Prozac case still requires some explaining, as does the conduct of the lawyers who consented to be bought off. The "bottom line" takes precedence over truth, decency, and ordinary kindness, and only John Cornwell's determination to tell the tale makes us ask these questions at all.