233 1 IN THE UNITED STATES DISTRICT COURT 2 FOR THE DISTRICT OF HAWAII 3 4 SUSAN K. FORSYTH, ) Civil No. 95-00185ACK Individually and as ) 5 Personal Representative ) of the Estates of June M. ) 6 Forsyth and William D. ) PAGES 233 - 409 Forsyth, and WILLIAM F. ) 7 FORSYTH, JR., ) ) 8 Plaintiffs, ) ) 9 vs. ) ) 10 ELI LILLY AND COMPANY, ) an Indiana corporation, ) 11 et al., ) ) 12 Defendants. ) __________________________) 13 14 TRANSCRIPT OF PROCEEDINGS 15 The above-entitled matter came on for trial on Friday, 16 March, 5, 1999 at 9:15 a.m. at Honolulu, Hawaii. 17 BEFORE: THE HONORABLE ALAN C. KAY 18 United States District Judge District of Hawaii 19 20 REPORTED BY: TINA M. STUHR, RPR, CSR #360 Notary Public, State of Hawaii 21 PACIFIC REPORTING SERVICES UNLIMITED, INC. 22 733 Bishop Street Suite 2090, Makai Tower 23 Honolulu, Hawaii 96813 (808) 524-PRSU 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 234 1 APPEARANCES: 2 For Plaintiffs: ANTHONY ANDERSON VICKERY, ESQ. Archer, Waldner & Vickery 3 2929 Allen Parkway Suite 2410 4 Houston, Texas 77019 5 KAREN BARTH, ESQ. Baum, Hedlund, Aristei, Guilford 6 & Downey 12100 Wilshire Boulevard 7 Suite 950 Los Angeles, California 90025 8 ROY K.S. CHANG, ESQ. 9 Shim & Chang 333 Queen Street 10 Suite 900 Honolulu, Hawaii 96813 11 For Defendant: ANDREW SEE, ESQ. 12 MICHELLE R. MANGRUM, ESQ. Shook, Hardy & Bacon L.L.P. 13 One Kansas City Place 1200 Main Street 14 Kansas City, Missouri 64105 15 EDMUND BURKE, ESQ. Burke Sakai McPheeters Bordner 16 Iwanaga & Estes 737 Bishop Street 17 Suite 3100 - Mauka Tower Honolulu, Hawaii 96813 18 Also Present: Catherine Itai 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 235 1 I N D E X 2 OPENING STATEMENTS: PAGE 3 Mr. Vickery 244 Mr. See 282 4 WITNESSES ON BEHALF OF PLAINTIFFS 5 DENNIS KIM 6 Direct Examination by Mr. Chang 314 7 Cross-Examination by Mr. See 348 8 WILLIAM DAVID FORSYTH, III 9 Direct Examination by Mr. Vickery 358 Cross-Examination by Mr. See 389 10 11 12 13 14 EXHIBITS ADMITTED INTO EVIDENCE: PAGE 15 Exhibit 165 - Maui Police Report 320 16 Exhibit 172 - Personal Notes of June 402 Forsyth 17 18 19 20 21 22 23 24 25 PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 236 1 THE CLERK: Civil No. 95-00185ACK, Susan K. 2 Forsyth, individually and as personal representative 3 of the estates of June M. Forsyth and William D. 4 Forsyth, and William F. Forsyth, Jr. versus Eli Lilly 5 and Company, an Indiana corporation, et al. 6 MR. VICKERY: May it please the Court. Good 7 morning, Your Honor. My name is Andy Vickery along 8 with Roy Chang and Karen Barth. We represent the 9 plaintiffs, Susan and Bill Forsyth. We're here and 10 ready for trial. 11 THE COURT: Good morning. 12 MR. SEE: May it please the Court, Your Honor, 13 I'm Andrew See. With me is Michelle Mangrum and 14 Edmund Burke. We represent Eli Lilly and Company and 15 are also ready for trial. With us is Ms. Catherine 16 Itai, who works for Eli Lilly and Company and will be 17 representing the company at the trial. 18 THE COURT: Good morning, ladies and gentlemen 19 of the jury. Whose exhibit is that? 20 MR. VICKERY: I set that up, Judge. 21 THE COURT: Would you move it, please? 22 MR. VICKERY: Yes, sir. 23 THE COURT: Thank you. 24 MR. VICKERY: You're welcome, Your Honor. 25 THE COURT: Ladies and gentlemen of the jury, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 237 1 you now are the jury in this case, and I want to take 2 a few minutes to tell you something about your duties 3 as jurors and to give you some instructions. At the 4 end of the trial, I will give you more detailed 5 instructions and those instructions will govern your 6 deliberations. 7 It will be your duty to decide from the 8 evidence what the facts are. You and you alone are 9 the judges of the facts. You will hear the evidence, 10 decide what the facts are, and then apply those facts 11 to the law which I will give you. That is how you 12 will reach your verdict. In doing so you must follow 13 that law, whether you agree with it or not. 14 The evidence will consist of the testimony of 15 witnesses, documents, and other things received into 16 evidence as exhibits in any fashion which the lawyers 17 agree or which I may instruct you to accept. You 18 should not take anything that I may say or do during 19 the course of the trial as indicating what I think of 20 the evidence or what your verdict should be. 21 Now, the parties to this case are plaintiffs 22 William D. Forsyth, Jr. and Susan Forsyth, 23 individually and as personal representatives for the 24 estates of June M. Forsyth and William D. Forsyth, Sr. 25 and the Defendant Eli Lilly and Company. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 238 1 The plaintiffs claim that their father, William 2 D. Forsyth, Sr. killed their mother, June M. Forsyth, 3 and committed suicide on March 4, 1993 because of his 4 ingestion of Prozac, a prescription antidepressant 5 medication manufactured by Defendant Lilly. 6 Plaintiffs claim that Defendant Lilly is liable 7 for damages because Defendant Lilly did not provide 8 adequate warnings concerning risks associated with the 9 use of Prozac to physicians such as the physician who 10 prescribed Prozac to William D. Forsyth, Sr. 11 Plaintiffs claim that as a direct result of 12 these inadequate warnings and his ingestion of Prozac, 13 William D. Forsyth killed his wife, June M. Forsyth, 14 and committed suicide. Plaintiffs are the surviving 15 children of June M. Forsyth and William D. Forsyth, 16 Sr. 17 The Defendant Eli Lilly and Company denies the 18 plaintiffs' claim. Defendant Lilly asserts that there 19 is no credible medical or scientific evidence to 20 support the claim that Prozac causes people to kill 21 and/or commit suicide. Defendant Lilly asserts that 22 William D. Forsyth, Sr. did not kill June M. Forsyth 23 and commit suicide because he took Prozac, but rather 24 because of his depression and other longstanding 25 mental and emotional problems, serious stressors in PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 239 1 his life, including deteriorating health and marital 2 problems and his inability to cope with day-to-day 3 events. 4 Defendant Lilly also asserts that it provided 5 adequate warnings concerning risks associated with the 6 use of Prozac to William D. Forsyth, Sr.'s prescribing 7 physicians, and that in any event, any alleged 8 inadequate warnings by Defendant Lilly did not 9 directly cause June M. Forsyth and William D. 10 Forsyth's deaths. 11 Now, the following things are not evidence and 12 you must not consider them as evidence in deciding the 13 facts of this case. Number one, statements and 14 arguments of the attorneys; number two, questions and 15 objections of the attorneys; number three, testimony 16 that I instruct you to disregard; number four, 17 anything you may see or hear when the court is not in 18 session, even if what you see or hear is done or said 19 by one of the parties or by one of the witnesses. 20 Some evidence may be admitted for a limited 21 purpose only, and I instruct you that an item of 22 evidence has been admitted for a limited purpose, you 23 must consider it only for that limited purpose and for 24 no other. 25 Evidence may be direct or circumstantial. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 240 1 Direct evidence is direct proof of a fact, such as 2 testimony by a witness about what that witness 3 personally saw or heard or did. Circumstantial 4 evidence is proof of one or more facts from which you 5 can find another fact. You should consider both kinds 6 of evidence. The law makes no distinction between the 7 weight to be given to either direct or circumstantial 8 evidence. It is for you to decide how much weight to 9 give to any evidence. 10 There are rules of evidence which control what 11 can be received into evidence. When a lawyer asks a 12 question or offers an exhibit into evidence and a 13 lawyer on the other side thinks that it is not 14 permitted by the rules of evidence, that lawyer may 15 object. If I overrule the objection, the question may 16 be answered or the exhibit received. If I sustain the 17 objection, the question cannot be answered and the 18 exhibit cannot be received. Whenever I sustain an 19 objection to a question, you must ignore the question 20 and must not guess what the answer might have been. 21 Sometimes I may order that evidence be stricken 22 from the record and that you disregard or ignore the 23 evidence. That means that when you are deciding the 24 case, you must not consider the evidence which I told 25 you to disregard. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 241 1 In deciding the facts in this case, you may 2 have to decide which testimony to believe and which 3 testimony not to believe. You may believe everything 4 a witness says or only part of it or none of it. In 5 considering the testimony of any witness, you may take 6 into account, number one, the opportunity and ability 7 of the witness to see or hear or know the things 8 testified to; number two, the witness' memory; number 9 three, the witness' manner while testifying; number 10 four, the witness' interest in the outcome of the case 11 and any bias or prejudice; number five, whether other 12 evidence contradicted the witness' testimony; number 13 six, the reasonableness of the witness' testimony in 14 light of all the evidence; and number seven, any other 15 facts of their unbelievability. The weight of the 16 evidence is to a fact. It does not necessarily depend 17 on the number of witnesses who testify. 18 I will now say a few words about your conduct 19 as jurors. First, do not talk to each other about 20 this case or about anyone who has anything to do with 21 it until the end of the case when you go to the jury 22 room to decide on your verdict. 23 Second, do not talk with anyone else about this 24 case or about anyone that has anything to do with it 25 until the trial has ended and you've been discharged PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 242 1 as jurors. Anyone else includes members of your 2 family and your close friends. You may tell them that 3 you are a juror, but do not tell them anything about 4 the case until after you've been discharged by me. 5 Third, do not let anyone talk to you about the 6 case or about anyone who has anything to do with it. 7 If someone should try to talk to you, please report it 8 to me immediately. 9 Fourth, do not read any news stories or 10 articles or listen to any radio or television reports 11 about the case or about anyone who has anything to do 12 with it. 13 Fifth, do not do any research such as 14 consulting dictionaries or other reference materials 15 and do not make any investigation about the case on 16 your own. 17 Six, if you need to communicate with me, simply 18 give a signed note to my courtroom deputy or my law 19 clerk, who will, in turn, give it to me. 20 Seventh, do not make up your mind about what 21 the verdict should be until after you have gone to the 22 jury room to decide the case and you and your fellow 23 jurors have discussed the evidence. Keep an open mind 24 until then. 25 At the end of the trial, you will have to make PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 243 1 your decision based on what you recall of the 2 evidence. You will not have a written transcript to 3 consult, and it is difficult and time consuming for 4 the reporter to read back lengthy testimony, so I urge 5 you to pay close attention to the testimony as it is 6 being given. If you wish, you may take notes to help 7 you remember what witnesses said. If you do take 8 notes, please keep them to yourself until you and your 9 fellow jurors go to the jury room to decide the case. 10 Do not let notetaking distract you so that you do not 11 hear other answers by witnesses. 12 When you leave, your notes should be left in 13 the jury room or actually, leave them right here in 14 this courtroom. Whether or not you take notes, you 15 should rely on your own memory of what was said. 16 Notes are only to assist your memory. You should not 17 be overly influenced by the notes. 18 The trial will now begin. First, each side may 19 make an opening statement. An opening statement is 20 not evidence. It is simply an outline to help you 21 understand what the party expects the evidence will 22 show. A party is not required to make an opening 23 statement. 24 The plaintiff will then present evidence and 25 counsel for the defendant may cross-examine. Then the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 244 1 defendant may present evidence and counsel for the 2 plaintiff may cross-examine. 3 After the evidence has been presented, I will 4 instruct you on the law that applies to the case and 5 the attorneys will make closing arguments. 6 After that, you will go to the jury room to 7 deliberate on your verdict. When a party has the 8 burden of proof on any claim, by a preponderance of 9 the evidence, it means you must be persuaded by the 10 evidence that the claim is more probably true than not 11 true. You should base your decision on all of the 12 evidence, regardless of which party presented it. 13 The plaintiff will now make their opening 14 statement. Mr. Vickery. 15 MR. VICKERY: Thank you, Your Honor. 16 MR. SEE: Your Honor, if Mr. Vickery writes on 17 the tablet, may I move around so I can see? 18 THE COURT: You may. 19 MR. SEE: Thank you. 20 MR. VICKERY: May it please the Court, Susan, 21 Bill. Good morning, ladies and gentlemen. This is a 22 case about drug-induced violence. Specifically, 23 Prozac-induced violence. Six years ago yesterday 24 morning, or perhaps the night before, we're not quite 25 sure, Bill Forsyth, who had been taking Prozac for ten PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 245 1 days, did something that was totally out of character. 2 This man who had been married for 37 years, 3 sometime during the course of the night or the early 4 morning, stabbed his wife approximately 15 times, and 5 then he went into the kitchen and he took a large 6 knife and he placed the end of it on a stool and 7 leaned down on it and killed himself. 8 It was that scene which my client, Bill 9 Forsyth, walked in on the following day. He had just 10 been with his parents the night before, and there was 11 nothing to indicate to him or to anyone else, 12 including the three doctors who treated this man or 13 saw this man in the six months before his death, that 14 he would ever do such a thing. 15 Now, that is the theme of our case. It is a 16 case about Prozac-induced violence, and in the time 17 that the Court has allowed me this morning, I want to 18 tell you five things about that that I hope will help 19 you put all of the evidence that you will hear in the 20 next weeks into context. 21 The first is that Prozac is an unsafe drug for 22 some people. For some people. There will be no 23 contention by the plaintiffs that it's unsafe for all 24 people or indeed for the majority of people, but that 25 it is unsafe for some people. We think about 3 to PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 246 1 5 percent of the people that take it have the physical 2 affects that lead to this kind of violent and suicidal 3 behavior. 4 The second is that the unsafeness of it relates 5 to a life and death matter, suicide and violence. The 6 third is that Eli Lilly and Company knew this. They 7 knew it before this drug was ever approved in this 8 country in 1987, years before it was ever prescribed 9 for William Forsyth on February 22, 1993. And that 10 knowing this, they failed to adequately warn the 11 physicians who prescribe this so those doctors would 12 know what to look for and know how to instruct their 13 patients to avoid this kind of tragedy. That they 14 failed to do that. 15 And the fourth is that under Hawaii law, which 16 governs this case -- let me say that again. Hawaii 17 law governs this case. Under that law, this makes Eli 18 Lilly liable for the damages for the wrongful deaths 19 of Bill and June Forsyth in this civil action. 20 And fifth, even though I don't need to prove it 21 to win, don't need to, what we think the evidence will 22 show you is that not only did Eli Lilly fail to warn 23 and instruct the doctors about this risk, but indeed, 24 they took rather extraordinary measures to mislead 25 those doctors, to misrepresent facts to them when the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 247 1 issue came up publicly about suicide, to suggest to 2 them that, don't worry about it. That's just a bunch 3 of crazy people on a lunatic fringe. Don't worry 4 about it. Keep prescribing the pills and keep 5 patients keep popping those pills. That they did 6 that. Now, those five things are the theme of our 7 case. 8 The Court as allotted me some time this morning 9 to sort of give you an overview of the evidence and 10 I'm going to try to watch my time and use it wisely 11 with you, but I would like to reiterate what Judge Kay 12 said to you, and that's what I say isn't evidence. 13 What Mr. See says isn't evidence. The evidence is 14 from the witness stand, from witnesses and from the 15 documents, which you will see. 16 As you might imagine, there are about a zillion 17 documents concerning Prozac, and let me talk to you 18 about our functions and our relationships through the 19 trial. First, being from out of state, from Texas, 20 let me say that I am honored, I'm honored that Bill 21 and Susan have chosen me to represent their family. I 22 am honored to be here in Aha Kaulike, this wonderful 23 room, this place of equity, to argue their case for 24 them. My job -- you see, my authority, whatever it 25 is, is derived solely from these two people. I have PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 248 1 their permission and their authority to speak on their 2 behalf in this courtroom. 3 The Court is the ultimate authority with 4 respect to the law in this case. Judge Kay will 5 provide you, as he said, with the substantive law, the 6 Hawaii law, that pertains to this case, and he also 7 serves as a filter, if you will, or a gatekeeper with 8 respect to the evidence to determine what's relevant 9 and what isn't. 10 And I'll tell you right now, when you see the 11 numbers on the exhibits, you'll see that like most 12 lawyers, we put everything together and we said, they 13 might need this. Let's get this exhibit, and they 14 might need this, too. And we've gone through a great, 15 long process with the Court saying, okay. Okay, guys 16 for both sides, let's just give the jury what's a 17 reasonable amount of paper for them to look at and to 18 consider that's relevant to these issues. So you will 19 have exhibits, and it will be a reasonable amount of 20 paper that I think you can focus on. 21 In the course of my remarks this morning, I'm 22 going to share with you excerpts from six of the 23 documents that you will see which focus on two 24 particular points in time with respect to this issue, 25 and I will say ahead of time that obviously, I'm PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 249 1 focussing or trying to focus your attention on the 2 things that I think are very persuasive from our 3 standpoint. And we don't have time to read the whole 4 document now. I'm just going to show it to you now 5 with an except so you can kind of put it in your mind 6 or make a note, if you want to, to make a note and put 7 it in the context of the overall case when you have 8 that opportunity. 9 So that is our function. That's my function. 10 That's the Court's function. Now, your function, of 11 course, as the Court explained to you so eloquently on 12 Wednesday, is that you have been selected from the 13 people of Hawaii and empowered by the federal 14 government to ferret out truth and do justice. Those 15 things. And I'm going to try to bring to you the 16 evidence from which you can do those two things, 17 ferret out truth and do justice. 18 So how do we -- how do we get our arms around 19 this case and the evidence and understand this case 20 which involves Prozac-induced violence, which involves 21 an unsafe drug and a risk of suicide that they knew 22 about and didn't warn about, which involves 23 affirmative misrepresentations? How do we do that? 24 One way to do it is look at it chronologically. 25 You're going to be hearing a lot about a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 250 1 chemical called serotonin. Some of you may be 2 familiar with that word as a result of Prozac and 3 other things like Phen-Fen and St. John's Wort. It is 4 kind of a word that people have heard about now. 5 What serotonin is is a chemical. It's a 6 chemical in the brain, but it is also throughout the 7 rest of your body, and it is one of those chemicals 8 described in a recent book as a molecule of emotion. 9 It is one of those chemicals that affect, not only our 10 biology, but our behavior. Now, that's not a new 11 phenomenon to us. You use your common sense and you 12 know that different things in your body can make you 13 feel different ways. Athletes like Ms. Barth get 14 endorphins when they run and it gives them a natural 15 high. I don't do that, but I can assure you standing 16 before you this morning that I have a little energy 17 because I'm a little nervous and a little excited and 18 a little appreciative, and it is my body that's giving 19 it to me. At the end of the day when I walk out, I'll 20 collapse. 21 And, of course, any woman that's ever had a 22 baby knows that the chemical changes that comes 23 sometimes in one's life, affect their mood and 24 behavior. Well, serotonin is one of many, many 25 chemicals in the brain that affects mood and behavior. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 251 1 So how did all of this get started? 2 What this drug Prozac claims to do is to block 3 the recycling mechanism of serotonin in the brain. 4 They call it an SSRI, selective serotonin reuptake 5 inhibitor. You'll learn all about that. I don't need 6 to take the time I have this morning to talk about 7 that. But what they claim is by doing that, it 8 somehow helps depression. It makes some people, I 9 think they claim about 66 percent of the people that 10 take it who are depressed, makes them better. It 11 makes them feel better. And it does work for some 12 folks. Now, how did all that come to be? 13 Well, it first started because scientists 14 noticed a relationship between serotonin, not in 15 depression, but in suicide. In autopsies of people 16 who have committed suicide, they've learned that the 17 serotonin levels were low in their brains as compared 18 to other people who have died for other reasons. And 19 so some bright scientists said, well, we know that 20 about half the people who commit suicide are 21 depressed. You'll hear some suicidology experts in 22 this trial, and that's one of the things you'll learn, 23 about half the folks that commit suicide are 24 depressed. 25 Interestingly, only about 1 percent of the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 252 1 people who commit suicide kill someone else first. 2 That's an exceedingly rare phenomenon that cannot be 3 explained by depression no matter what Mr. See says. 4 But they said, well, gosh, if people who die by 5 suicide have lower serotonin, perhaps if there was a 6 drug that would elevate their serotonin, then they 7 would -- that's a way to treat depression. That's a 8 way to treat depression. 9 And so Lilly had a drug which was actually 10 synthesized or made by them. It's not a natural 11 substance. It's a chemical that they made in the lab 12 in 1972, and that chemical was called fluoxetine or 13 hydrochloride fluoxetine to be more precise, but that 14 doesn't sell real well. When it was marketed, it has 15 become known as Prozac, and it's one in the same. And 16 so they said, if serotonin affects suicide and suicide 17 is related to depression, then maybe this drug, which 18 affects serotonin, can affect depression. How they 19 think that it can skip the third step, you'll have to 20 decide from the evidence. Prozac affects serotonin 21 which affects depression, but not affect suicide? 22 But in 1972, this drug was synthesized and made 23 and you will hear from Mr. See, you'll see a time line 24 of how long it takes things to get through the FDA. 25 They file, first of all, an IND, Investigative New PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 253 1 Drug Application, and they say to the federal 2 regulators in Washington, we have this new drug and we 3 want to check it out. We want to check it out and see 4 what it might be useful for. And they start with 5 animals to see if it kills them, to see is this drug a 6 poison. 7 Let me tell you right now, it's real hard to 8 kill yourself by overdosing on Prozac. You almost 9 can't do it, which is one of the marketing advantages 10 of this drug. You almost can't do it. 11 So they went through and they tested it, and 12 there's a long process by which they sought to have it 13 approved for sale in this country and in other 14 countries. And I want to get somewhat ahead in the 15 story now because it takes a long time. Mr. See is 16 right about that, it takes a long time. 17 In the early eighties, what they were noticing 18 as they experimenting with it on people is that there 19 seemed to be an inordinately high number of people who 20 were dropping out or getting a condition you'll learn 21 about called akathisia, who were agitated or who were 22 nervous. Akathisia, the way I can describe it and 23 you'll hear experts talk about, but to me it's like 24 having ants in your pants, okay, or stepping in a 25 wasp's nest, or feeling like you want to jump out of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 254 1 your skin. It is an extremely uncomfortable physical 2 sensation that long before Prozac was known to lead to 3 violence and suicide, akathisia. 4 And so as they began to accumulate data from 5 the clinical trials and begin in various countries to 6 try to get regulatory approval to sell it, some folks 7 began to say, wait a minute. It's helping some 8 people. It's not affecting others, but it sure seems 9 that the suicide rate is high. It seems that the 10 folks that are thinking about suicide is high. That 11 the folks that are dropping out because of agitation 12 and psychotic conditions, that that's high. So what 13 happened? 14 1985, the BGA, which is the German counterpart 15 of our FDA, the BGA, told Lilly we're going to reject 16 this drug. Let's see why. Ms. Barth. 17 January 29, 1985 regarding fluoxetine 18 registration. "We unofficially received our 19 confirmation that fluoxetine was discussed by the 20 Commission A, at the BGA, on January 21st. Two major 21 concerns seem to be the reason that the registration 22 was not accepted. One, the efficacy was questioned. 23 This may be due to the experiences in study design and 24 classifications used in the United States versus 25 Germany." Efficacy just means does it work or not. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 255 1 They were questioning whether it worked. 2 "Number two, suicidal risk." This is in 3 January of 1985. What did Lilly do, Ms. Barth, if 4 you'll move to the next one, is they said well, we 5 better look at this. Let's do a risk benefit 6 analysis. A risk benefit analysis, something that 7 probably some of you are probably familiar with. 8 Let's look at what it can do, what are the benefits to 9 us or others, and what are the risks? What are the 10 risks? 11 On the screen is a preliminary report dated 12 March 29, 1985, two months later of the Benefit/Risk 13 Considerations According to the State of Knowledge of 14 March 29, 1985 concerning the Antidepressant Drug 15 Fluoxetine. 16 Now, what I'm going to tell you right now may 17 surprise you, but as they weighed the benefits and 18 risks, they said, maybe it's possible if we limit the 19 number of patients, that we will get this suicide 20 problem down to a, quote, tolerable level. 21 The benefits versus risk consideration for 22 fluoxetine currently does not fall clearly in favor of 23 the benefits. Therefore, it is of greatest importance 24 that it be determined whether there is a particular 25 subgroup of patients who receive better to fluoxetine PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 256 1 than any other antidepressant drug so that the higher 2 incidents of suicide attempts may be tolerable. 3 I assure you, ladies and gentlemen, I promise 4 you that the first person, and probably every person 5 from Eli Lilly that sits on that stand and raises 6 their right hand to God and promises to tell the 7 truth, I will ask how tolerable is it? How many 8 people have to kill themselves? How tolerable? 9 This is 1985. For whatever reason -- thank 10 you, Ms. Barth -- the process in Germany was delayed. 11 They seem to put more emphasis on getting approval 12 here in the United States where, unfortunately, I'm 13 going to show you in the course of this time, they 14 have some pretty good friends in high places in 15 Washington. They seem to want to do that before they 16 got it done in Germany. 17 In the fall of 1987, Prozac, fluoxetine, was 18 approved by the Food and Drug Administration in 19 Washington, and they began to sell it in 1988. Now, 20 prior to that time, there had only been people who 21 were hand chosen for the clinical trials. Prior to 22 that time, they had hand chosen doctors, psychiatrists 23 to administer the drug to them. Prior to that time, 24 the people who were getting the drug, they had 25 excluded anyone who was at a serious suicidal risk. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 257 1 They had excluded them in the test, and they allowed 2 these doctors to give what's called a common sedative, 3 they allowed them to give in addition to the Prozac 4 drug. They were taking a drug called benzodiazepine, 5 a sedative, a downer, to take care of the problems of 6 agitation, akathisia, the things that would lead to 7 violence and suicide that they knew about from way 8 back, at least as far as 1985, but when they hit the 9 market in 1988, it was more widely described. 10 Doctors began to describe and prescribe across 11 the country for depressed people and they did so quite 12 frequently. Within two years, the problem that the 13 Germans had seen in 1985 began to rear its ugly head 14 in the United States, and in February of 1990, the two 15 well-known doctors, Dr. Martin Teicher, and 16 Dr. Jonathan Cole, published a paper in a respected 17 journal, a psychiatric journal that other doctors 18 would read, and that paper has a big title called, 19 "Treatment Emergent Suicidality," but, basically, what 20 these two doctors were saying is we have six patients 21 who, just like Bill Forsyth, had never been suicidal 22 before. They had never thought of violence before, 23 who, on this drug, not only began to think about 24 killing themselves, but to kill themselves in 25 extremely violent ways and we think you ought to know PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 258 1 about that. That's why we're going to publish this 2 article. 3 Now, I've got to tell you, Dr. Cole, you will 4 learn is what Lilly calls an opinion leader. In other 5 words, he's the guy that has some gray hair that's 6 published a lot. These are two Harvard physicians. 7 Dr. Cole was one of those hand-picked group that Lilly 8 had hired to test this drug on other people. He's not 9 some Johnny-come-lately. He was an opinion leader, 10 and he and Mr. Teicher and a nurse that was a 11 co-author with him on the paper named Carolyn Glod 12 published this paper. We need to look out for this. 13 You need to know about this. Colleagues out there in 14 the medical world, you need to know about that. 15 What was the response of Eli Lilly in January 16 and February of 1990? They found out about this 17 article, that it was coming out, actually before it 18 came out. A man named Dr. Charles Beasley, who I will 19 talk about somewhat later, is a scientist for Lilly, 20 got on the airplane and flew to Boston before their 21 article hit the street and talked to them and began to 22 have meetings at Eli Lilly and Company on the 23 executive floor where the top guys are and the top 24 scientists in the whole company, Dr. Leigh Thompson, 25 who I trust Lilly is going to bring. I can't bring PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 259 1 him. I can't force him to come. I can't bring anyone 2 past the bounds of Hawaii, but he's on the witness 3 list and I hope they'll bring him because I got some 4 questions for him. 5 Dr. Leigh Thompson, the top scientist of Lilly, 6 says Lilly, this company can go down the tubes if we 7 lose Prozac. Ms. Barth. February 7, 1990, from Leigh 8 Thompson, "I am concerned about reports I get 9 regarding UK attitude toward Prozac safety. Leber," 10 you'll learn later, that's Dr. Paul Leber at the FDA, 11 a man that Lilly describes as our defender, "suggested 12 a few minutes ago we using the CSM database to compare 13 Prozac aggression and suicidal ideation with other 14 antidepressants in the UK." That's United Kingdom. 15 That's Britain. Why Britain? Why not here? 16 This CSM database, they do better records over 17 there than we do perhaps because of socialized 18 medicine and there's more information in a computer 19 database, and that's why. And Dr. Leber suggested 20 that Lilly use that database, which they've never 21 done, but you'll hear considerable testimony from the 22 expert we're going to be bringing from England or 23 Whales, Dr. David Healy, about a study that was done 24 using that database. 25 "Although he is a fan of Prozac and believes a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 260 1 lot of this is garbage, he is clearly a political 2 creature and will have to respond to the pressures. I 3 hope Patrick realizes that Lilly can go down the tubes 4 if we lose Prozac, and just one event in the UK can 5 cost us that. You know my prejudice about Patrick, 6 but if I hear one more problem about not covering 7 Prozac safety in the UK, Allan, I'm going to really be 8 up in arms. Leigh." That's February 7, 1990. 9 Now, the week before the marketing people had 10 said, well, what are we going to do about this? What 11 are we going to do? We've got this article from two 12 members about a risk of suicide, knew there were 13 suicide thoughts in patients. What are we going to 14 tell the doctors? You see, the way Lilly informs 15 doctors like Dr. Randolph Neal here at Castle, a good 16 doctor, just needed all the information or Dr. Riggs 17 Roberts on Maui who prescribed it for him, a good man. 18 He just needed all the information. 19 The way Lilly keeps those people up to speed, 20 they just don't send them the package insert with the 21 tiny little print. They send people to answer the 22 doctor's questions. So they prepared a memo for those 23 people before this article ever hit the streets and 24 said okay, this article is about to hit the streets. 25 You guys need to know what your marching orders are PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 261 1 about. And you know what their marching orders were? 2 To develop a marketing plan. Let's look at their 3 memo. 4 January 30, 1990, Dista sales representatives 5 regarding "The Emergence of Intense Suicidal 6 Preoccupation During Treatment with Fluoxetine." The 7 article by Dr. Teicher and others and they say, 8 "Enclosed is an article. The article discusses case 9 reports of six depressed patients, some with other 10 psychiatric diagnoses, all of whom had complicated 11 psychiatric histories. After approximately two to 12 seven weeks on Prozac treatment, all six patients 13 developed, quote, intense, violent suicidal 14 preoccupation." 15 Now, that's the first page of the document. 16 Let's look at the second page and see what their plan 17 was on how they were going to deal with this. 18 "Because these issues are not part of our current 19 marketing plan, you should not initiate discussions on 20 these articles. However, when asked to comment on the 21 issues raised on this article, you should attempt to 22 determine their level of competency and experience or 23 their concern regarding the information based on this 24 article; on the summary provided in this letter, and 25 attempt to place into perspective these six cases; and PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 262 1 refer to medical correspondence in Indianapolis. 2 "Again" -- in case they didn't get it the first 3 time -- "Again, since these issues are not part of our 4 current marketing plan, discussions should not be 5 initiated by you." That is January 1990. 6 For the next several months, the political 7 creature and others at the FDA made some inquiries 8 about this issue. People were looking at it and, in 9 fact, by the summer of 1990, it got beyond just the 10 psychiatric journals and into the public domain. 11 Things like 20/20, Nightline, the AP, the Wall Street 12 Journal. Things that you and I might see. 13 Now, let's see what happened in July of 1990 as 14 this matter began to get broader public attention. 15 What happened is when the press -- there was an 16 article in the Wall Street Journal that came out and 17 the press began to call, not only Lilly, but began to 18 call Dr. Paul Leber at the FDA and others at the FDA. 19 What about this? What are you guys going to do about 20 this? What they did -- what these government 21 regulators did that are supposed to be protecting the 22 public health is that they worked hand in hand with 23 Lilly to put a cap on the numbers. Because, as we've 24 already learned, Dr. Leber thought this was all 25 garbage anyway and Lilly had decided years ago that PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 263 1 some level of suicide was tolerable. 2 Let's look at the memo from Leigh Thompson, the 3 chief scientist of Eli Lilly, July 18, 1989. "Paul 4 Leber called yesterday. I contacted him at 6:15 this 5 morning, a half hour conversation; very, very 6 pleasant, with Paul and Tom Laughren," who is another 7 doctor at the FDA. The call was about suicide. 8 "They said this morning's Wall Street Journal, 9 in their mind, was trivial, and the reporter had 10 called them. However, this issue is building and will 11 not go away." That's the first page of the 12 memorandum. 13 "Paul asked for chronology of all label changes 14 on Prozac." They were thinking about the label 15 whether or not it might need some warnings. "Paul is 16 taking a position in talking with outside folks today 17 that Lilly and FDA working together on the suicide 18 issue and following closely the post-marketing events, 19 that there are no denominators, and the best that can 20 be done is to put a, quote, cap or number -- on the 21 number of events, put a cap on it." That's July 1990. 22 It was consistent with Lilly's marketing plan. 23 You see, this is a case about the marketing of the 24 drug. It's not a case about whether Prozac is a drug 25 that's bad for all people. It's not. It is 3 to PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 264 1 5 percent of the people who are at a life and death 2 risk. And it is a case about marketing. Something so 3 simple. So simple. 4 You know, I've noticed it in my home and I've 5 noticed it here in Hawaii over the past couple of 6 years as I've come here many times regarding this 7 case, that there are signs -- when I go to the beach, 8 there are signs that tell me what the surf is like. 9 I've been warned about the undertow. Sometimes 10 there's signs that warn about the jellyfish. 11 Sometimes in downtown Honolulu, there's signs that 12 warn about the window washers up above. It is so 13 simple. What would it have cost Lilly to provide this 14 kind of information to doctors like Dr. Randy Neal and 15 Dr. Riggs Roberts? 16 Well, the issue didn't go away quite yet in the 17 summer of 1990. It continued through the fall of 18 1990. Let's look at a November 1990 memorandum. 19 Ms. Barth back up. Let me put this in the context to 20 the jury. 21 The issue is not a live one just here in the 22 United States. It was live in Germany as well, and as 23 they were attempting to, quote, put a cap on the 24 numbers, one of the very important things was how are 25 these events reported. How are they reported to the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 265 1 government? When we keep track of them in the 2 computers, how do we report it? 3 If someone tries to slit their wrists or tries 4 to hang themselves and we make a report about it, do 5 we say violent suicide attempt? And what they were 6 doing were they were coding them all to overdose. 7 Now, I've already told you that you can't kill 8 yourself on an overdose of this drug, but the way that 9 the information was being accumulated by Lilly, skewed 10 the picture. If it is coded by overdose, then we can 11 put a cap on the number. 12 There was a man named Claude Bouchy, who is the 13 head, I believe, of Lilly's operation in Germany, and 14 he had a real problem with that, ladies and gentlemen. 15 He had a real problem with that. Let's look at his 16 memo. 17 November 13, 1990, regarding "Adverse Drug 18 Event Reporting on the Suicide in Fluoxetine. Our 19 safety staff is requested to change the event term 20 'suicide attempt' as reported by the physician to, 21 quote, overdose. Hans has medical problems with these 22 directions, and I have great concerns about it. I do 23 not think that I could explain to the BGA, to a 24 judge," perhaps to a jury, "to a reporter or even to 25 my family why we would do this, especially on the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 266 1 sensitive issue of suicide and suicidal ideation. At 2 least not with the explanations that have been given 3 to our staff thus far." He was concerned about that. 4 That's the fall of 1990. 5 Now -- thank you, Ms. Barth. So what we've 6 seen is in '85 the issue was concern -- they were 7 concerned that the BGA rejected because of suicide. 8 We've seen that in March Lilly did a risk benefit 9 analysis, and they decided that some number of dead 10 people would be tolerable. 11 The next year -- let me talk about my clients 12 for a minute. The next year, 1986, William Forsyth, 13 Sr., retired. Retired with substantial assets to be 14 quite frank. He was a real aggressive businessman. 15 Not aggressive in the sense of being a bad guy, but 16 aggressive in the sense of being a go-getter. 17 He had a business, a car rental business, in 18 Los Angeles out at the airport, and apparently, in 19 1986, the airport said, Mr. Forsyth, we need this 20 space. We're going to take your space, but we'll buy 21 out your business, or something like that. And he 22 retired. And for the next four years, they continued 23 to live in California where Bill and Susan had grown 24 up. 25 Now, Bill, Jr. -- can I call you Billy? His PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 267 1 family calls him Billy. Billy had moved to Hawaii by 2 this time, and you may hear Lilly say, well, Bill, Sr. 3 and Billy may have been at some odds because Bill, Sr. 4 wasn't all that happy with Billy's ambition. You see, 5 he made a life choice that he didn't need to have the 6 ambition and the money that his father sought his 7 whole life. That he would rather live here in the 8 beauty of Hawaii and live a simpler lifestyle with his 9 wife and children and that's the choice he made, and 10 his father took some time to come around to 11 understanding that. 12 So for the four years they were retired, from 13 '86 to '90, and in 1990, they moved to Maui. So at 14 the same time, in 1990, when the Forsyths were moving 15 to Maui, that's when all this Teicher and Cole article 16 was going on, remember. February and January there 17 was the Teicher article. There was a marketing plan. 18 In July, Dr. Thompson was on the phone at 6:15 in the 19 morning with Dr. Leber and they were going to put a 20 cap on the numbers, and in November, Claude Bouchy had 21 the pangs of conscience about explaining it to a judge 22 or even to his family. 23 That gets us up to 1990. And now, I want to 24 tell you what I think the evidence will show you about 25 my clients after that. When they moved to Hawaii and PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 268 1 built a beautiful house on Maui, Bill Forsyth, to put 2 it quite frankly, I think he kind of got under his 3 wife's feet. I don't know if any of you have 4 experienced that, but sometimes when folks are -- the 5 man is off working his whole career, and then he 6 retires and they're at home together and the kids are 7 grown up, all of a sudden they're on top of one 8 another, and it caused some problems. It caused some 9 problems between them. And they had some marital 10 problems. 11 You know, I apologize to you now, ladies and 12 gentlemen, for the fact that there's a lot of very 13 personal things that we have to bring out here. 14 Things that are personal and painful to Bill and 15 Susan. There are some things that are going to be 16 visually unpleasant for you, particularly this 17 afternoon when Detective Kim comes and talks to you 18 about the investigation of the scene, and I apologize 19 to you for that. I know it's uncomfortable for you. 20 It's uncomfortable for us, but it is necessary if they 21 are to accomplish their goals here. And let me say 22 something about that for a minute. 23 Eli Lilly and Company, apparently, is going to 24 suggest that Bill and Susan Forsyth are pursuing this 25 case for some kind of secondary gain. I guess they're PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 269 1 going to suggest that this young man who left the 2 ambitious lifestyle and chose Hawaii over it, is just 3 interested in money. They're going to question their 4 motivations about this. And one of the things you're 5 going to learn in this trial is that both Bill and 6 Susan have been very active with a non-profit group 7 called "The Prozac Survivors Support Group." They've 8 tried to take their own family tragedy and turn it, in 9 some way, to public good, and that's why we're 10 enduring the pain of having these very personal 11 matters about their parents' marital relationship, 12 most of which, as you might imagine, they were not 13 really intimately aware of during their parents lives 14 brought out. 15 But in 1991, Bill Forsyth left Hawaii, left his 16 wife here, went back to California to give them both 17 some space. He was gone for a while, but they 18 reunited. In the fall of -- I'm sorry, in the 19 following year, in 1992, he left again in July, and he 20 left kind of abruptly. You'll hear testimony from his 21 psychologist, Dr. Tom Brady, who helped him through 22 his marital problems with his wife, helped him and 23 June both, that his MO, his way of dealing with stress 24 and confrontation with his wife was not to hit, was 25 certainly not to stab her. It was to leave. It was PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 270 1 to go away. That's what he tended to do, and he did 2 it again in July of 1992. He went back to the 3 Mainland where Susan lived, where he had friends and 4 support groups as he struggled with this 37-year 5 commitment to his wife and to the real troubles that 6 they were having. 7 He decided to get professional help in 8 September of 1992. This is going to be real 9 important, so I'm going to write these dates down 10 because I will always, through this trial, try to 11 pinpoint, as Lilly talks about problems between the 12 Forsyths, I'm going to be trying to pinpoint the time 13 because that's just critically important. 14 July of '92, Bill goes to L.A., to California. 15 September, he begins to see Dr. Brady, and Dr. Brady 16 is a psychologist, and he was helping him with therapy 17 and marital therapy and he was getting double doses or 18 more. He was going once or twice a week for double 19 sessions each time, so it was real intense therapy to 20 try to help him through this time. 21 By October, by October, he asks his wife to 22 please join him in L.A. and work with him with 23 Dr. Brady through their marital problems, which she 24 readily does. They start going on October the 29th, 25 and they go for about six weeks. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 271 1 Dr. Brady will explain it to you far better 2 than I as to what that process did for these people, 3 but I think the evidence will show you that they 4 started out, as you might imagine, sitting apart. I 5 mean, the body language, the facial expressions were 6 of people who were mad at one another, who needed some 7 professional help in opening up and sharing their 8 concerns with one another. 9 They ended up on December the 4th, 1992 coming 10 in and sitting together, holding hands, making love, 11 going on trips, talking about moving to Palm Springs 12 and buying a new house, and I don't think you will 13 hear anyone say, anyone, anything other, about their 14 relationship after that, than it was better than ever. 15 When they got back, Bill developed a 16 depression. He developed a depression, and he felt 17 low. You're going to learn about clinical depression. 18 It's more, ladies and gentlemen, than simply feeling 19 the blues. It is a diagnosable condition that is a 20 serious concern, and he developed that and he went to 21 see Dr. Riggs Roberts on December the -- I better 22 check my dates here. December the 16th, and he began 23 to see Dr. Roberts weekly after that. And you'll have 24 the opportunity to listen to Dr. Roberts' testimony. 25 Bill was anxious. He was depressed, and he was PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 272 1 given different medicines for those things. Now that 2 concerned him a little bit because one of the other 3 things that may be brought up is the fact that Bill 4 was an alcoholic. He hadn't had a drink in many, many 5 years, but he had fought and conquered the horrible 6 problem of alcoholism, and having done that and having 7 been dry for so many years, he was exceedingly 8 concerned about taking any mind-altering substances, 9 yet Dr. Roberts thought that would help him and 10 prescribed it for him and so that's what he tried. 11 And he worked with Dr. Roberts on a weekly basis 12 taking medication and going in for therapy sessions 13 for the next couple of months. 14 The medicine that Dr. Roberts gave him didn't 15 work. It wasn't Prozac. It didn't work. And on 16 February 22nd, Dr. Roberts decided to try this new 17 drug, Prozac. And he prescribed it for Mr. Forsyth 18 and said, try this antidepressant. It might help you. 19 And the next day he got a call from his patient 20 reporting something that he had already come to 21 describe as the Prozac miracle. Mr. Forsyth called 22 the next day and said I am 200 percent better. Now 23 this drug is working great. I'm just happy as a lark. 24 Imagine his surprise when he got the call the 25 very next day from Billy that said my dad was in the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 273 1 hospital. This man had never been hospitalized 2 really. He said, I've got to go to the hospital. 3 Today. This very day. Can't wait until tomorrow. 4 Today. And Dr. Roberts called him and said, Bill, 5 what's wrong? 6 My dad has had a horrible change. Yesterday he 7 was great, but today he's had a horrible change and he 8 wants to go to the hospital. And Dr. Roberts said, is 9 he there? I want to talk to him, and he talked to 10 him. And he said, based on what I saw two days ago 11 and what he said to me yesterday, I don't think he 12 needs to go to the hospital, but I'm not there. You 13 are. And if he's saying he wants to go and what 14 you're observing says he needs to go, then by all 15 means, take him. And so on 2/24, after two days on 16 Prozac, he came to Castle Medical Center where he was 17 seen by Dr. Randolph Neal and he -- Dr. Neal 18 prescribed Prozac or continued him on Prozac. There 19 may be a day there when he really didn't have a pill. 20 It is not entirely clear to me, but continued him on 21 Prozac for the duration of the time that he was there. 22 Now, one of the issues is going to be whether 23 Mr. Forsyth had any thoughts of suicide before he ever 24 took Prozac. Was he like all six of the patients that 25 Drs. Teicher and Cole reported on who had never had PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 274 1 those kinds of thoughts and developed intense suicidal 2 preoccupation on Prozac or had he thought about it 3 before? 4 Three different mental health professionals, 5 doctors, have seen this man and not a one of them 6 noticed that, even though with depression you would 7 look for it; Dr. Tom Brady in the fall of 1992, 8 Dr. Riggs Roberts weekly starting in December of '92, 9 and Dr. Randolph Neal every day in the hospital at 10 Castle Medical Center from then until March 3rd, but 11 there is an entry in the medical records from a man 12 named Rick Poole, who may or may not be called, that 13 said he has had some suicidal thoughts in the last 14 month. You'll have to decide for yourself. Did this 15 man really have these thoughts in the last month and 16 Dr. Riggs Roberts just flat missed it on a couple of 17 visits or is it more likely than not, that they 18 started when he had this tremendous downturn on 19 February 23rd or after February 23rd on Prozac? Was 20 he like the other patients that Teicher and Cole 21 reported on? 22 On March the 3rd, Mr. Forsyth was released at 23 his own request, sent home with his wife. He was 24 excited about going home with his wife, went back to 25 Maui. Billy was with them. They went over and had a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 275 1 dinner that night at their home. You'll hear his 2 description of his father. He still wasn't the same 3 father he had always had, but he was glad to be out of 4 the hospital and glad to be home. 5 You'll hear his description of his mother that 6 night. This woman had been married to this man 37 7 years. He had just checked out of a mental hospital. 8 She didn't hesitate to stay there alone with him at 9 night. She didn't hesitate to go to bed with him at 10 night. 11 Sometime that night inexplicably he stabbed her 12 to death and then he took his own life. Now, he was 13 supposed to go the next day, he and June were going to 14 go with Billy on the boat. He has a boat that he 15 takes folks like you and me out on a boat to see 16 whales and dolphins, and that sort of thing, and they 17 were going on a whale-watching trip the next day. And 18 when they didn't show at the boat at the end of the 19 day, Billy went by his house to check on his parents 20 and you will see very shortly, this afternoon when 21 Detective Kim comes, the scene into which he walked. 22 Essentially, ladies and gentlemen, that is a 23 brief overview of the case. It is a case about 24 Prozac-induced violence. It is a case about a company 25 that decided some levels of suicide is tolerable. A PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 276 1 company that decided not to warn about the risk that 2 it knew about, but instead to take extraordinary 3 measures -- now, they warned in Germany. They didn't 4 give a real decent warning, but they gave better than 5 they gave here. A different warning in Germany about 6 the risk of suicide because the BGA made them. But 7 it's a case about a company that withheld information, 8 but not just withheld, a company that went to 9 extraordinary lengths to provide disinformation or 10 misinformation about this risk to encourage the 11 doctors that it's not a problem. It's not a problem, 12 all this stuff here. Wall Street Journal, we won't 13 rely on them. Teicher and Cole, you know, why rely on 14 those guys. Don't worry. Keep prescribing it. 15 That's what this case is about. 16 If I prove to you the five things that I 17 said -- actually, one I don't have to prove is the 18 law. I expect the judge will give it to you. That 19 it's unsafe to some people; that the unsafety is 20 because of suicide; that they knew it and failed to 21 warn; and indeed that they misrepresented; and then 22 the fifth, under Hawaii law, the law that you and I 23 are sworn to uphold, at the end of this case, I hope 24 that you would have ferreted out the truth and I will 25 ask you to do justice on behalf of my clients, Bill PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 277 1 Forsyth and Susan Forsyth. And at that time, you'll 2 say, well, who are we? You know, 12 people in Hawaii, 3 what justice can we do? What difference can we make? 4 Ladies and gentlemen, I'm going to prove to 5 you, in the course of this trial, that your verdict -- 6 I'll prove to you from documents -- that your verdict 7 will make a difference in Washington, D.C. to the FDA, 8 and that perhaps by that verdict, people that call the 9 hotline at the Prozac Survivors Support Group and 10 other people in this country will learn what Lilly 11 should have been telling them all along, and perhaps 12 because of that verdict, other lives will be saved. 13 That's why we're here. Thank you. 14 THE COURT: Let's take a 15-minute break. 15 Please be back at 10:35. 16 (Whereupon, a recess was taken at 10:20 a.m.) 17 THE COURT: Mr. See. 18 MR. SEE: May we take a matter up at side bar, 19 Your Honor? 20 THE COURT: My courtroom deputy thought we 21 could avoid that and didn't bring in the jury. Okay. 22 (Whereupon, the following proceedings were had 23 at side bar out of the presence of the jury.) 24 MR. SEE: In his opening statement, Mr. Vickery 25 mentioned Phen-Fen. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 278 1 THE COURT: In his closing argument? 2 MR. SEE: There was some elements of that in 3 there, too. He mentioned Phen-Fen. Phen-Fen is a 4 highly popularized litigation. I'm sure the Court -- 5 THE COURT: Highly popularized? 6 MR. SEE: It's a diet drug litigation. 7 THE COURT: What's that word, litigation? 8 MR. SEE: Litigation. 9 THE COURT: I've never heard that used in 10 conjunction with a drug. 11 MR. SEE: There's a lot of cases about 12 Phen-Fen. In my mind, that's not consistent with the 13 Court's prior rulings that other litigation and other 14 cases ought to be out of that. 15 THE COURT: You mean Fentress? 16 MR. SEE: No, Phen-Fen. It's a name of a diet 17 drug. 18 THE COURT: And there's a lawsuit? 19 MR. SEE: There is. There's hundreds of 20 lawsuits and it's all over the papers. It's in 21 magazines. I believe the mentioning of that in this 22 situation to that situation is prejudicial. 23 My request is that the Court give the jury an 24 instruction that Mr. Vickery mentioned Phen-Fen and 25 that Phen-Fen hasn't got anything to do with this case PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 279 1 and the jury should disregard. 2 THE COURT: You want me to mention litigation 3 or just the drug? 4 MR. SEE: No, sir, just Phen-Fen. 5 THE COURT: So you want an instruction that 6 Mr. Vickery mentioned Phen-Fen and the Court instructs 7 the jury that it has nothing to do with this case? 8 MR. SEE: Yes, sir, and they should disregard 9 it. 10 THE COURT: Mr. Vickery. 11 MR. VICKERY: Judge, I don't believe I violated 12 any order, and I certainly didn't talk about any other 13 litigation, but I have no objection to the Court 14 telling them. 15 THE COURT: Okay. 16 MR. SEE: There is another matter, Your Honor, 17 which is probably more serious and it has to do with a 18 comment Ms. Mangrum heard made in the presence of our 19 jurors. I'll let her tell you about it. 20 MS. MANGRUM: I got in the elevator with two of 21 the jurors, and another attorney, Charles Ferrera, 22 said to me, in the presence of the jurors, he asked me 23 do you travel -- 24 THE COURT: Who's Charles Ferrera? 25 MR. BURKE: He's a local attorney, Your Honor, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 280 1 who was sitting out here this morning. 2 THE COURT: Not associated with this case? 3 MR. BURKE: No. 4 MS. MANGRUM: This is the Phen-Fen case. 5 THE COURT: Chris Ferrara. 6 MR. BURKE: No, Charles. There are two of 7 them. 8 MS. MANGRUM: He asked me in the presence of 9 these two jurors, one of who was Mr. Hom, and I'm not 10 sure who the other juror was, whether Mr. See and I 11 travelled around the country defending all of these 12 Prozac cases, which is an issue that's not supposed to 13 be before the jury, and I simply said, "There are 14 jurors here," and did not answer the question. 15 MR. SEE: I don't know what to do about that, 16 Your Honor, but I wanted to bring it to your 17 attention. 18 THE COURT: You want to bring those two jurors 19 in, maybe after lunch, and see if they remember 20 anything about it or instruct them that they're not to 21 consider any other litigation in the case that's just 22 before the court. 23 MR. SEE: I don't know if doing that, if it 24 highlights the matter. Well, it's just an overall 25 instruction to the jurors. You are not to consider PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 281 1 anything you hear out in the corridors or out in the 2 elevators. 3 THE COURT: I've already done that in my 4 preliminary jury instructions. 5 MR. SEE: That might be the best way to handle 6 it, Your Honor. 7 THE COURT: I can incorporate that in the 8 Phen-Fen instruction. And what would that be again? 9 MR. SEE: I want to remind you that you are not 10 to listen to any comments made by anyone in the 11 hallways or the elevators or around the courthouse. 12 None of those comments have any impact on this case at 13 all. Perhaps, the only thing you are to consider is 14 the evidence that is presented in this courtroom. 15 THE COURT: All right. Does Dr. Healy have a 16 rebuttal to this latest Dr. Jick's -- 17 MR. VICKERY: I haven't read this latest 18 Dr. Jick thing, Your Honor. 19 THE COURT: I want a response. It's a very 20 serious matter. 21 MR. VICKERY: He'll be here on Tuesday. He's 22 in transit. We will have a response Tuesday. 23 THE COURT: Well, I would just reiterate that 24 both parties have a strong motivation to settle this 25 case. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 282 1 (Whereupon, the following proceedings were had 2 in open court without the jury present.) 3 THE COURT: We'll have to take a short break to 4 let the jury come back in. 5 (Whereupon, a recess was taken at 10:47 a.m.) 6 THE COURT: I do want to instruct the jury that 7 Mr. Vickery mentioned in his opening statement 8 Phen-Fen, and that has nothing to do, absolutely 9 nothing to do with this case and you are to totally 10 disregard that. 11 Also, I want to remind you that you're not to 12 listen to any comments by anyone outside of this 13 courtroom. You are to consider only the evidence that 14 comes into this courtroom. Totally disregard anything 15 you hear outside of this courtroom, regardless of whom 16 might say it. You are to only consider the evidence 17 that is submitted in this trial. 18 Mr. See, you may make your opening statement 19 now for Defendant Eli Lilly and Company. 20 MR. SEE: Thank you, Your Honor. May it please 21 the Court and Mr. Vickery. Good morning to all. I'll 22 reintroduce myself. I'm Andy See. When I grew up, I 23 don't think I knew another person named Andy. 24 Everybody was a Bill or a John or a Tom, and now we're 25 falling all over one another, but it's good to have PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 283 1 all the Andys here. 2 I represent Eli Lilly and Company. Eli Lilly 3 is a drug company. It makes prescription medicines. 4 It's located in Indianapolis, Indiana, and it has been 5 since 1876. Lilly's been doing business there making 6 prescription medicine for 120 years. 7 We've placed this up-ended trash can here so 8 that the smart lawyers won't fall over this microphone 9 line. Hopefully, I won't. 10 This is our chance to tell you and visit with 11 you about what the case is about and what we believe 12 the evidence will show. This case is about a good 13 drug and a very, very bad, powerful disease. The 14 disease is called major depression. 15 I want to put up, just to demonstrate for you, 16 what the symptoms of major depression actually are, 17 how doctors diagnose the condition, so that you will 18 be able to recognize, as the evidence comes in, which 19 one of these things you can find. 20 Major depression includes someone who has a 21 depressed mood. This is more than just being sad or 22 down. It is a depressed mood that lasts for a long 23 time. It doesn't go away. People have diminished 24 interest in pleasure or in their normal activities. 25 People who get depressed don't want to go out and do PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 284 1 anything. They lose interest in things that had 2 interested them before. 3 People with major depression often have 4 significant, either weight loss or weight gain. They 5 often have problems with sleeping. The most common 6 problem with major depression and sleeping is 7 insomnia, simply not being able to go to sleep, or 8 waking up very early in the morning. Sometimes people 9 with major depression sleep all the time, so it is 10 sleep disturbance. 11 People with depression can have psychomotor 12 agitation or retardation. Now, what is that? 13 Psychomotor retardation is someone who just doesn't 14 want to do anything. Stay at home, sit in the chair, 15 stay in bed with the covers pulled up, move slowly. 16 Just do nothing. Some people with depression have 17 that. It is a retardation. Everything is slowed 18 down. 19 But with depression you can also have 20 agitation, and that's speeded up, being excited. 21 Fatigue or loss of energy is very common in 22 depression. A person is just tired all the time, 23 doesn't want to go out and do anything. No energy, 24 and very often feelings of worthlessness; I'm just not 25 worth anything. Or feelings of guilt, especially PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 285 1 inappropriate guilt where the person just doesn't 2 really have anything to be guilty about, but they have 3 these terrible feelings that they are guilty. All 4 part of the disease. 5 Also, diminished ability to think or 6 concentrate. People with depression often simply 7 can't read a book because they can't focus their mind. 8 They can't do the normal business tasks, for example, 9 that they can usually do. And what is particularly 10 important in this case, as you will see, one of the 11 ways doctors diagnose a major depression is the 12 presence of what we call suicidality, and that means 13 thinking about suicide, life is not worth living. I 14 can't go on anymore. It is just not worth it. And 15 actively thinking about killing yourself. Actually, 16 acting out those thoughts in a suicide attempt, and 17 very tragically, part of this powerful, deadly disease 18 is suicide itself, an inherent part of the disease. 19 So that's the bad, powerful disease that this 20 case is about, and what you need to know, what the 21 evidence will be is that 80 percent, 80, 8-0 percent 22 of people who have major depression, diagnosed major 23 depression, have suicidal thinking. 80 percent. 24 40 percent of people with major depression actually 25 have a suicide attempt as part of their disease, and PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 286 1 tragically, 15 percent of all people with major 2 depression go ahead and sometime in their lifetime 3 commit suicide. 15 percent. That's what this disease 4 is about. It is a deadly disease. If untreated, or 5 if the patient doesn't respond, it can be a deadly, 6 deadly disease. 7 Now, this case is about a gentleman named 8 William Forsyth. Mr. Forsyth is from California. As 9 Mr. Vickery told you, he was a very successful 10 businessman, had owned a rental car agency outside of 11 the Los Angeles airport. What kind of a guy was he? 12 Well, he was a guy that we would refer to as a fellow 13 with a Type A personality. A real go-getter, on the 14 go all the time. Needed a challenge. Loved to work. 15 Loved to be confronted with a challenge so it could be 16 overcome. Needed to be busy doing something all the 17 time. Actually would get restless if he wasn't up 18 around doing something. He was not the kind of guy 19 who would enjoy staying home all day Sunday reading 20 the paper or watch TV. That was not Mr. Forsyth. He 21 was a guy that got out and got things done. That was 22 part of his personality. 23 As Mr. Vickery said, Mr. Forsyth retired a 24 little bit early for his taste, sold out his business, 25 did very, very well, and made a decision in 1990 to PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 287 1 move to Maui where his son, Mr. Bill Forsyth, who is 2 here today in the courtroom, lives and they built a 3 home. 4 Now, after June and William Forsyth moved to 5 Maui, they found that their life there was not exactly 6 what they had thought it might be. Mr. Vickery 7 referred to some problems, and there will be evidence 8 about that, and the problems were these: Mr. Forsyth 9 was one of the people who just could not adjust to 10 retirement. He just could not slow down. He needed 11 something to do. He needed to be active and be 12 productive, and he never really found anything to do. 13 And because of that, he was very unhappy in his 14 retirement, and you'll hear the testimony from his 15 family members about that. 16 William and June Forsyth experienced some 17 communication problems in their marriage, and one of 18 the things that brought on -- sort of brought this 19 communication problem to a head, now that he was 20 retired and they had moved to Maui, he was at home a 21 lot. During his working life, he had not been at 22 home. He worked all the time. A real go-getter. But 23 now he was at home, kind of under foot, and he and his 24 wife were, I think one of the therapists said, 25 literally on top of one another. And because of that, PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 288 1 they needed to work out some new relationship, but 2 that was not working out well and they were not 3 communicating well together. 4 Mrs. Forsyth's role in the marriage was also 5 changing. As she looked towards her retirement, she 6 wanted to be a person who was an equal partner in the 7 marriage, and this was a little bit different than 8 before. She wanted to participate in the 9 decision-making of the marriage, and that changing 10 role of Mrs. Forsyth also was a problem for William. 11 There was another problem and that was the role 12 of religion, what role religion was going to play in 13 their lives. Mrs. Forsyth was a very sincere, very 14 devout born-again Christian. She belonged to the same 15 church as her son on Maui. She was a real believer. 16 It was important to her, and a very important part of 17 her life. She listened to Christian videotapes and 18 listened to Christian radio, and read Christian books 19 and so on. Mr. Forsyth was -- he did go to church 20 with his wife, but he was not as involved in living 21 the full born-again Christian lifestyle as his wife, 22 and that was -- that became an issue between them. 23 His wife, June, wanted him to adopt beliefs more 24 similar to hers. So that was a cause of some stress 25 between them. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 289 1 Now, during his retirement, William Forsyth 2 adopted a role -- a way of coping with the stresses 3 and problems that he had at home in getting along with 4 his wife and nothing to do in retirement and so on, 5 and his method of coping with those problems was to 6 get away from them. His psychologist called it 7 running away. 8 June Forsyth was a woman who had considerable 9 verbal skills. She was sort of a talker, and her 10 talking with Mr. Forsyth was a stress that was put on 11 him that he just couldn't -- he couldn't cope with it. 12 It was just too much input. He would move to the next 13 room, and if Mrs. Forsyth followed, he would leave the 14 house. And if the stress got too much, he even would 15 leave the island and go back to the Mainland, and that 16 happened on a couple of occasions. 17 Mr. Vickery has already told you that June and 18 William separated in their marriage two times, one 19 during the summer of 1991. And the evidence will show 20 you that when Mr. Forsyth left his wife at that time, 21 in 1991, he simply left the island and didn't tell her 22 that he was going or where he was going. She had no 23 idea until he finally called, but he went back to the 24 Mainland and stayed for a time. They reconciled and 25 then in the summer of 1992, essentially the same thing PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 290 1 happened. Mr. Forsyth left the island and returned to 2 the Mainland. 3 They seemed to reconcile again, went through 4 some counseling, and returned to Maui in December of 5 1992. December of 1992 is when William Forsyth became 6 ill with this disease, with major depression. He had 7 always been, his whole life, been an anxious -- an 8 anxious person. When the doctors talk about anxiety, 9 it is apprehension, uneasiness, worrying about things 10 that really aren't all that important. He had been 11 that kind of person, had been an anxious person all 12 his life. In fact, he went to the doctor right before 13 he and Mrs. Forsyth came back to Maui and was 14 prescribed some medication for his anxiety. So when 15 he came back, he had this anxiety problem and he also 16 became ill with this disease, major depression. 17 Now, what the evidence will show is that right 18 after they got back to Maui, something happened, and 19 the evidence -- there's no controversy about this. 20 Mr. Forsyth underwent a personality change. Why? 21 Because he became seriously ill with major depression. 22 So we're talking about December of 1992 and his 23 personality change. His family members really tell it 24 the best. He wasn't the same guy. His personality 25 changed. Well, what happened? How did he change? PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 291 1 Number one, as we've already discussed, he 2 became depressed, depressed mood, sad. Not happy, no 3 joy, sad. He had his anxiety problem. He had 4 something that may have been panic attacks, but 5 certainly anxiety attacks. He would have from time to 6 time acute, immediate, serious feelings of very severe 7 anxiety, so much so that he would have physical 8 symptoms, heart palpitations. His heart would beat 9 really fast. He would be very afraid and then after a 10 time, those would pass. Those panic or anxiety 11 attacks would happen to him from time to time. 12 He lost weight. He lost interest and pleasure 13 in all the things that he liked to do. Because he was 14 a fellow that really liked to do lots of things and 15 always on the go and doing something, he was a radio 16 control model plane hobbyist. Lost interest in that. 17 He loved his grandchildren. He stopped going 18 and playing with them. He lost interest in that. He 19 would start staying at home, sort of withdrawing from 20 everybody else. He had a problem with sleeping. He 21 developed feelings of guilt. He had no energy. He 22 was tired all the time, and he was withdrawn. All of 23 these things are part of the personality change that 24 happened after they came back to Maui in December of 25 '92. PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 292 1 Now, a few more things. As time went on, he 2 developed a fear of being alone. He wanted his wife 3 to stay home with him all the time. He was afraid 4 that he wouldn't be able to cope with just day-to-day 5 living activities. Again, more fear. He had a very 6 low self-worth. I'm worthless. I'm no good. I'm not 7 good for anything. He became hopeless. He began 8 having feelings of helplessness. Not only without 9 hope, but there's nothing I can do about it. I can't 10 help myself. Now, we know all of these things because 11 of Mr. Forsyth's work with the psychologist and 12 psychiatrists. We have their records and you'll hear 13 them testify. 14 Problem number one for William Forsyth, as he 15 told his psychiatrist, I'm lonely. Problem with 16 loneliness. He became dependent on his wife. He felt 17 he couldn't do anything for himself and needed to have 18 her there all the time. If she had to go to the 19 grocery store, come right back. Afraid to stay home 20 by himself. And he lost his mental sharpness. 21 Now, you'll hear all these things in testimony 22 from witnesses. This is how William Forsyth's 23 personality completely changed after he became ill 24 with this disease. 25 Now, we've already heard it was December 7th of PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 293 1 '92 that William and June came back to Maui from the 2 Mainland. William went to see the psychiatrist, 3 Dr. Roberts, around the middle of December and he was 4 diagnosed as having major depression. 5 Now, Dr. Roberts prescribed some medication for 6 him, an antidepressant drug called Pamelor, and 7 Mr. Forsyth took Pamelor up until towards the end of 8 February. He was also taking a drug that had been 9 prescribed for him for his anxiety, which is called 10 Xanax. So he was taking these two drugs during this 11 period of time with these symptoms. And what 12 happened? 13 He became more withdrawn, even reclusive, 14 stayed at home all the time, in bed, covers pulled up 15 to his nose in the afternoon. He wouldn't go out. 16 The hopelessness came out because Mr. Forsyth 17 said, I'm not going to get over this. So we come up 18 to -- he went to see Dr. Roberts regularly through 19 this period of time, and we'll go over that to see if 20 this was doing him any good, but what we'll see and 21 what Dr. Roberts will tell you is with the Pamelor, 22 the antidepressant drug, he was not getting any 23 better. It just didn't help him. It could not break 24 his major depression. 25 Now, two things happened on February the 22nd PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 294 1 of 1993. In the morning, so I'll put a.m., 2 Mr. Forsyth called one of his doctors back in Los 3 Angeles, on the Mainland, and had a conversation with 4 him, and he told Dr. Hawley, I think I need to be in a 5 hospital. That was the morning. 6 Dr. Hawley told him, you need to go see your 7 psychiatrist. Go to him. He said, okay. I've got an 8 appointment this afternoon, and, in fact, he did. So 9 in the afternoon of the same day, I'll put p.m., 10 Mr. Forsyth did go to see Dr. Roberts and Dr. Roberts 11 decided that he tried the Pamelor long enough. 12 Pamelor was not breaking Mr. Forsyth's depression, and 13 so he would try a different antidepressant. And I'll 14 talk about trying different antidepressants in just a 15 second, but just to get the facts straight, this is 16 the first time that Mr. Forsyth ever got Prozac in the 17 afternoon of February the 22nd. 18 Now, let's go to February the 24th. What 19 happened on February the 24th? Mr. Vickery told you 20 about February the 23rd, the day after Mr. Forsyth 21 took Prozac, so he had probably taken one pill or two 22 pills. You will hear that Prozac, like just about 23 every other antidepressant, takes two or three or four 24 weeks to become effective. It just needs to build up 25 in your system, and the antidepressant drugs are PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 295 1 basically all like that. That's one of the problems. 2 They don't take effect immediately. It takes a little 3 while before they have an antidepressant effect. 4 So 2/24, what happened was Mr. Forsyth had one 5 of his panic/anxiety attacks, and what did he say? He 6 said the same thing he said the morning of the 22nd. 7 Well, I think I need to be in a hospital. But the 8 panic attack passed. 9 Mr. Forsyth, Jr. called Dr. Roberts and said, 10 you know, dad thinks he needs to be in a hospital. 11 That was arranged. They arranged to fly to Oahu so 12 that he could be checked into Castle Medical Center in 13 the psychiatric unit. And what did Mr. Forsyth say 14 when he got there? Well, I feel okay. I wish I 15 hadn't overreacted. But I'm here and I'm glad I'm 16 here, and maybe I can get some help for the problem 17 that I'm having. 18 So he's in Castle Medical Center from 19 February 24th until March the 3rd. Now, how is 20 Mr. Forsyth behaving during this time? Well, we know 21 that because we have -- we have the testimony of 22 family members and we also have the hospital records 23 and the observations of the doctors. 24 On February 24th, after the panic/anxiety 25 attack had passed and Mr. Forsyth said, well, I wish I PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 296 1 hadn't overreacted, how was he? Well, he was calm. 2 He was sedate. He was not pacing. He was not 3 fidgety. And he's checked into Castle and he stays 4 for about ten days. 5 Now, one of the things that you will hear, and 6 why this evidence here is very important, has to do 7 with the condition that Mr. Vickery mentioned, and we 8 should talk about that. And that condition is a 9 specific medical condition called akathisia. 10 Akathisia. Make sure I can spell it. Akathisia 11 literally means -- it's a medical condition. This 12 kath is either in the Greek or Roman, I'm not sure, 13 for chair. It means literally a person that can't sit 14 down. A person that can't sit down. 15 And there are, just like for major depression, 16 there are specific diagnostic criteria for akathisia, 17 and here's what those are. You have to have two 18 things. One is a subjective complaint of 19 restlessness; that is, a feeling, an inner feeling of 20 restlessness, that's the way you feel, and one or more 21 of actual physical symptoms. And those physical 22 symptoms are this: Fidgety or swinging legs, rocking 23 back and forth. Somebody that's like this 24 (indicating). But it is not just doing it for a 25 minute or two, it's somebody that can't stop rocking PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 297 1 back and forth. Swinging legs, someone who will sit 2 and swing and literally cannot keep their legs still. 3 Pacing, and then an inability to sit or stand still. 4 So for akathisia, you have to have both. One, 5 this inner feeling of restlessness, the way you feel, 6 and the other, the way you act, some physical action, 7 rocking back and forth, can't sit down. People 8 literally will do this, up and down, up and down. 9 They can't remain in one place. And why that's 10 important is, and what you will be able to do now, as 11 the evidence comes in, you'll be able to look for, 12 were these symptoms of akathisia present? 13 Because the evidence will show that on the 24th 14 of February, Mr. Forsyth did not have akathisia. What 15 was he? He was calm, not pacing; sedate, and not 16 fidgeting. And he goes into Castle Medical Center -- 17 go back one second. 18 When Dr. Roberts prescribed Prozac, he also 19 prescribed two other medications for Mr. Forsyth. One 20 of them is called Inderal and then he also had a 21 medication called Desyrel. The Inderal is the 22 medication that doctors sometimes prescribe for 23 symptoms of anxiety. The Desyrel is prescribed for 24 sleep. So Dr. Roberts was treating the depression, 25 the anxiety, and the sleep problems. He was getting PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 298 1 those three medications. 2 Now, after Mr. Forsyth goes into Castle, Dr. 3 Neal takes over his treatment and this medication. I 4 think there may have been a day lapse, but basically, 5 the same medication goes on through his stay at 6 Castle. He's taking Prozac, Inderal, and Desyrel. 7 The Xanax is the medication that Mr. Forsyth was so 8 concerned about because of his history of alcoholism. 9 He was told that Xanax, he could be dependent on it, 10 and he didn't like that at all and he wanted to get 11 off. So the doctor weaned him off of the Xanax, but 12 he was still on the Prozac, Inderal, and Desyrel 13 during his time at Castle. 14 And what do we know talking to the doctors and 15 looking at the medical records during the time that he 16 was at Castle Medical Center, what was Mr. Forsyth's 17 condition? He had no agitation. He was calm. He was 18 quiet. No side effects from Prozac. And what we know 19 most particularly, because we just flat out asked 20 Dr. Neal, his psychiatrist, did he have akathisia 21 during the time he was in Castle? No. No akathisia. 22 Now, one of the most important facts is this: 23 When Mr. Forsyth went and checked into Castle Medical 24 Center, he was taken over by his son and his wife went 25 with him. As part of his intake, he sat down with the PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 299 1 counselor and his counselor asked him about his 2 history, what are you thinking? Any problems? That 3 sort of thing. One of the things they talk about is 4 suicidal thinking. They always ask that, especially 5 someone coming in with major depression, absolutely, 6 because suicide is part of major depression. 7 So they ask and Mr. Forsyth says this: Well, 8 my depression has been getting worse the last couple 9 of months, and in the past month I have had suicidal 10 thinking. So by his -- this would be about 1/24. 11 Suicidal thinking past month. That's in the medical 12 records at Castle. This was told, incidentally, not 13 to just one counselor, but to other social workers at 14 different times. Yes, I've been having suicidal 15 thinking the past month. 16 Now, the other point in time where we know, we 17 know about Mr. Forsyth's condition was the time he got 18 out of Castle Medical Center, June, his wife, flew 19 over to Oahu here and picked him up and they flew 20 together back to Maui. Bill Forsyth met them. They 21 had dinner apart and then they got back together that 22 evening. They had a long visit that evening of March 23 the 3rd. 24 And what do we know about how Mr. Forsyth was 25 behaving at that time? Well, we know that he was PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 300 1 calm. That he was quiet. That he was relaxed. That 2 he was not agitated, no pacing. That he was sitting. 3 That's a description of how Mr. Forsyth was at this 4 point in time. So the evidence will show, and you 5 will see there wasn't any time after Mr. Forsyth got 6 Prozac in the afternoon of February 22nd when he had 7 this problem, this condition akathisia. He didn't 8 have it. And the tragic end to the story is, 9 apparently, Mr. Forsyth did kill his wife and then 10 killed himself sometime that night because they were 11 found the next day. 12 Now, what can you make of all that? Well, the 13 evidence -- you're going to hear evidence on another 14 topic and that will be about specifically what 15 happened in this case; that is, a homicide followed by 16 a suicide where someone kills another and then turns 17 around and kills themselves. It's not a common event, 18 but it happens more often than you think, and there 19 have been many studies looking at, well, who are those 20 people? What is it that causes people to do that? 21 And you'll hear about that information and here's what 22 we know about homicide/suicide. 23 Through the studies, we actually know what it 24 looks like. We know who the people are that commit 25 this kind of an act, the joint act of a PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 301 1 homicide/suicide, and this is what the studies show. 2 First, who does this kind of a thing? Who? The who 3 is it is done by men and they kill their female 4 partner, spouse or long-time partner. The man is the 5 perpetrator. The woman is the victim. That's what 6 homicide/suicide looks like. Men kill female partner. 7 That's the who. 8 Why? Well, here's what we know the studies 9 show, because of a broken marital or romantic 10 relationship. That's the why. Where does this 11 happen? The studies have looked at this. A 12 homicide/suicide, you can say murder/suicide if you 13 want, male kills the female partner because of a 14 broken relationship. It happens at home and more 15 often than not, it happens in the bedroom. 16 There are at least two kinds of sets of this. 17 One concerns younger couples. One concerns older 18 couples. With the younger couples, it's much more 19 likely that there is a jealousy, sort of a malignant, 20 really not a good jealousy at all, but a jealousy 21 feeling that there's been infidelity and so on. 22 That's what's common in younger couples. 23 In older couples what do we see? One factor, 24 declining health, and that is seen in either the man 25 or the woman. And what do we also see? An underlying PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 302 1 mental illness, and you know what that is? That's the 2 major depression, in the man. 3 What are the triggers? In other words, what 4 happens that seems to bring this on or precipitate 5 this act? Well, the triggers are stress. And what 6 can that be? Marital, financial, health, family, but 7 some stress. And now, an important consideration, 8 what about prior violence? Is this something we see 9 in cases where there has been domestic abuse, a 10 pattern, and then the man just finally kills the wife 11 or the domestic partner? Is that what we see? 12 Again, there's a two-way breakdown. In younger 13 couples, not always, but pretty common prior domestic 14 violence. In older couples, and you will see the 15 studies right on this, absent or rare. So that's what 16 homicide/suicide looks like as you will hear the 17 evidence come in. 18 Now, it is true, it is true that William 19 Forsyth was taking Prozac at the end of his life. 20 That's true. But the evidence will show you that it 21 wasn't Prozac that caused these two deaths. The 22 evidence will show you that this is, in fact, a 23 classic case of homicide/suicide among older couples. 24 William Forsyth killed his wife because their 25 marital relationship was broken. He did it at home in PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 303 1 their bedroom. He was in declining health. He was 2 terribly bothered by it. You'll see his own writings 3 that he was bothered. I just can't cope with it 4 anymore. I just can't take care of my affairs 5 anymore. I can't -- he was very worried. You will 6 also hear that Mrs. Forsyth herself, unfortunately, 7 had recurring major depression. 8 The stresses, marital problems, the 9 communication problems they had where he just 10 couldn't -- in his condition, could not cope with the 11 communication that she wanted to have in their 12 marriage. He would get up and leave the house. He 13 couldn't stand it. And you'll also hear in the 14 evidence that prior history of violence in older 15 couples, absent or rare. 16 Now, this case ultimately comes down to, on the 17 one hand, a scientific fact, does Prozac cause people 18 to suicide? Does Prozac cause people to kill other 19 people? And you'll hear the scientific evidence on 20 that fact. It also comes down to the practical, real 21 life story of what happened in a very tragic way to 22 these people, and you will see that Prozac is not 23 necessary to explain this homicide/suicide. All the 24 facts are there. 25 Now, I also want to tell you just a little bit PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 304 1 about antidepressants. Mr. Vickery told you that 2 antidepressants work through chemicals in the brain. 3 That's correct. There was a revolution in medicine, 4 in psychiatry, in the early 1960s. Before there 5 really was no good medication to treat depression. 6 And the kind of depress -- antidepressant was 7 developed called tricyclic antidepressant, and it's 8 abbreviated TCA. And these were the first drugs that 9 could practically help people with depression, and 10 they're very good. 11 Problems? They have some side effects that 12 people just don't like. These side effects are not 13 particularly dangerous. You get a dry mouth, a cotton 14 mouth, but, I mean, it's really a dry mouth, blurry 15 vision, constipation. Some people just said, you 16 know, I don't like that. I don't want to take it. 17 Well, the danger is, if the people are not willing to 18 take the antidepressant medication, then their 19 depression will go untreated. 20 Tricyclic antidepressants took about two, 21 three, four weeks to become effective, just like 22 Prozac. And this is another fact, I think Mr. Vickery 23 referred to it, the tricyclic antidepressants were not 24 able to help everybody. Only 60 or 70 percent of 25 depressed patients would respond to any particular PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 305 1 antidepressant. Tricyclic. 2 Prozac is no different. Prozac will help about 3 two-thirds or 70 percent of the people, and the other 4 30 percent, it just is not able to help them. And 5 what doctors do, like Dr. Roberts did, will try 6 someone on one antidepressant for six weeks or eight 7 weeks or so, and see if they get relief. If it 8 doesn't seem to work for them, then they're probably 9 one of those people that just are not going to respond 10 to that particular one and the doctor will try another 11 one, which is exactly what happened in this case. 12 Now, the real danger in tricyclic 13 antidepressants is this: They take several weeks to 14 become effective, all right? So when you first start 15 taking them, it's not going to work right away. It 16 may not work for you at all. You might be one of the 17 one-third people that it just doesn't work. You might 18 have a depression so strong, so powerful that the drug 19 is simply not able to break it. 20 And what happens to people who have major 21 depression who don't respond to the drug treatment, 22 they can become suicidal even while they're taking the 23 antidepressant. It happens because the drug wasn't 24 working. It hadn't kicked in yet. Maybe they were 25 one of the people that it wasn't going to work for PACIFIC REPORTING SERVICES UNLIMITED, INC. (808) 524-PRSU 306 1 them. Maybe the depression was just too strong. It 2 happens and it's well-known. And the danger with 3 tri