510 Book Reviews

Second World War was actually a grimmer ordeal for the front-line soldier in certain
campaigns, such as the breakout from Normandy, at least as suggested by loss rates. It
was just as grim, if not worse, in physical terms in other campaigns, such as Burma. None-
theless, this is an impressive contribution to the historiography, not least because it is
readily accessible for non-medical specialists. It is also admirably comprehensive, covering
all theatres and including the experiences of British prisoners of war, Japanese atrocities
against medical staff, and the medical contribution following the liberation of the
German concentration camps. Hard medical evidence, statistics, reminiscence, and anec-
dotal detail are all woven together to provide a compelling account. Harrison has set out
to remedy the neglect of medical aspects of the war and has more than succeeded in his
intention. This book is essential reading for historians of the Second World War.
Ian F. W. Beckett
University College, Northampton
doi: 10.1093/shm/hki062

David Healy, Let Them Eat Prozac: The Unhealthy Relationship between the
Pharmaceutical Industry and Depression, New York: New York University Press,
2004. Pp. 368. $29.95 (hbk). ISBN 0814736696.
David Healy recounts in this volume the story of selective serotonin reuptake inhibitors
(SSRIs) and the emergence of their links with suicidal behaviour in the 1990s. As one
of the key consultants and witnesses throughout the era when pharmaceutical companies
such as Lilly defended themselves against accusations of shoddy science, cover-up, negli-
gence, and failure to warn, he was deeply involved in events and often privy to insider
communications. As a prominent researcher and an acknowledged authority on psycho-
pharmacology, he provides an impressive breadth of scientific understanding. As a strong
supporter of psychopharmacological remedies for mental disorders, he cannot be accused
of anti-psychiatry bias. Taken together, this means that the conclusions reached in the
book are all the more important.
Healy is not, however, without an axe to grind. He mentions his brushes with the psy-
chiatric and medical establishment in trying to draw attention to the dangerous side-effects
of this class of anti-depressants at the height of their remarkable popularity; his battles with
lawyers and Big Pharma when his evidence was overlooked and his earlier statements were
taken out of context; his struggles to publish in academic journals; and what he calls the
Toronto affair, when his outspokenness cost him a prestigious post. His contract with the
University of Toronto was breached following a lecture on conflict of interest as a key
concern in modern science. He later sued and settled out of court. Like that lecture,
this book is about conflict of interest in modern science, although it also touches on
several other vices such as greed, deceit, moral ambiguity, and the wilful neglect of
those consumers and patients whose interests modern science, medicine, and the
pharmacology industry purport to serve. The science is complex, fascinating and
instructive.
Despite the use of regulation evidence-based medicine protocols to establish the effec-
tiveness of Prozac and its ilk, Healy demonstrates limitations in the rating scales which had
no category for the particular side-effects that these new drugs produced and also high-
lights genuine ignorance over the meaning of ambiguous data. This, taken together
with some plain old skullduggery (massaging the data for instance), blinded researchers
to unexpected and alarming side-effects. Agitated and impulsive states, suicidal thoughts
and suicidal behaviour occurred early in the drug regimen for a significant number of
subjects. In a series of trials when the drug companies stood accused over actual suicides
and homicides they challenged this causal claim, insisting instead that it was the disease
 Book Reviews 511
(depression) which resulted in the deaths rather than the product. As this defence was
successful, Healy initiated a study, and demonstrated that subjects without depression
would show the same pattern of dangerous side-effects when given the drugs. The corpor-
ations resisted his findings and so, too, did much of academic medicine and science.
In demonstrating the systematic penetration of medical science by industry, Healy
reveals a dismaying array of invitations to corruption. A ghost-writing system accounts
for a large percentage of papers in prestigious journals. Senior researchers serve as
consultants to drugs companies and at the same time as purportedly disinterested advisors
to regulating bodies. Drug companies underwrite and increasingly dominate the substance
of what is learned at scholarly meetings, and review boards which scrutinize trial protocols
are now sometimes privatized, at least in the USA, and run by the organizations that
conduct clinical trials for the drug companies.
As with his earlier books, Healy is careful to avoid demonizing individuals in the
pharmaceutical industry. Nevertheless, something must be done and the author has
some proposals. Industry might be persuaded to permit independent experts to have
access to their research data, which are at present proprietary and as such in conflict
with the ethos of scientific inquiry. Better data collection and use of information about
side-effects could be organized. He offers two other, less realistic, suggestions. Patient
cooperatives might take over the design and management of clinical trials and these
drugs should be sold over the counter (he believes that consumers experiencing
side-effects would simply choose to discontinue the drug). Ultimately, however, Healy
concludes at the end of this clear and well-written book that in the current situation
the values of business and health care are at odds. Is medical business just another business
he asks, and answers that if not, companies cannot simply play by business rules and aim at
maximizing profits. At some point the patient must come first.
Jennifer Radden
University of Massachusetts at Boston
doi: 10.1093/shm/hki063

Cesare Lombroso and Guglielmo Ferrero (translated and with a new introduction
by Nicole Hahn Rafter and Mary Gibson), Criminal Woman, the Prostitute, and
the Normal Woman, Durham: Duke University Press, 2004. Pp. 320. $21.95
(pbk). ISBN 0 –8223 –3246 –9.
Many scholars will be grateful to the editors for their endeavours in ensuring that a full
English translation is now available of this important work. The purpose of this volume
is not to answer questions but to provide material that will stimulate debate about Lom-
broso’s theories. Cesare Lombroso (1835 –1909) was an Italian physician, psychiatrist, and
criminal anthropologist who claimed to have discovered the ‘born criminal’ that he
believed was a new human subspecies. Lombroso may have been the first to apply
science to the study of crime and his core idea, that some people are born criminal, con-
tinues to be debated today in various guises. The legal implication of this idea, that ‘some
offenders are not fully responsible for their acts’ (p. 3), was crucial to Lombroso’s theories
and remains a major factor in criminal jurisprudence today.
This volume is a new translation of Lombroso’s La donna delinquente or Criminal
Woman, originally published in Italian in 1893. In 1895 it was translated into
English as The Female Offender, but this contained only one part of the original
work and omitted much of the material on prostitutes and the commentary on the
‘normal’ woman. The original English translation bore little resemblance to the orig-
inal text and was subject to ridicule; the excessive editing was largely responsible for a
confused and, in many cases erroneous, assessment of Lombroso’s work. The editors of