For those who know Angela Bischoff, the less visible but equally energetic partner of much-missed Tooker Gomberg, it's something of a surprise to hear her say, "There's already a big environmental movement. It's happening without me." Kind of like hearing David Frum say, "Neo-cons? Who needs 'em?"
Bischoff was Gomberg's travelling partner on an epic bicycle tour of the world's green projects, and a co-conspirator in the outrageous antics of Gomberg's 2000 Toronto mayoral campaign and all his other storied commando actions.
Since the cold March of 2004 when Gomberg threw himself from a Halifax bridge, Bischoff has been shifting direction and raising her own kind of dust, not Gomberg-style with flaming passports or Robin Hood outfits, but in a series of info meetings.
These appearances have nothing to do with the revival of the coal industry or the almost daily smog warnings, but with the antidepressant Remeron RD, which Bischoff links to the morbidly agitated state Gomberg was in when he ended his life. Her message concerns the sadly underplayed connection between pharmaceuticals and suicide.
Gomberg's first major depression struck in 2001, says Bischoff, after a punishingly active stint that included a climate change conference in The Hague that ended in his arrest, the Quebec City summit protest and his mayoral bid, in which he racked up 51,000 votes. He spent much of 2001 sampling alternative therapies - St. John's wort, massage therapy, various natural cures and, finally, an antidepressant called Celexa - none of which had any effect. Gomberg finally bounced back on his own.
In early 2004, however, when he was in Halifax, out of work and having big self-doubts, depression hit again.
This time "he just went right for the meds," she says. His psychiatrist prescribed Remeron, thinking its antihistamine properties would help with insomnia. The sedative effects wore off quickly, and Gomberg was agitated again, and feeling even worse. Says Bischoff, "This was a classic textbook case of adverse drug reaction."
The doctor urged him to stay with the medication, and doubled his dose from 15 to 30mg and then to 45. Bischoff recalls Gomberg's talk turning to suicide, "as far as I'm aware, for the first time in his life."
It's a cruel irony that in the months just before and shortly after Gomberg's death, Health Canada issued public advisories about antidepressants, connecting them to "increased risk of suicide-related events." Meanwhile, across the border, the Federal Drug Administration was announcing its requirement of "black box" warnings citing the risk of suicidal behaviour as a possible adverse effect.
A series of recent court cases in the United States and the UK against drug-makers like GlaxoSmithKline, makers of Paxil, an alleged factor in recent teen suicides, have pushed the controversy into the open.
These days when Bischoff speaks, she doesn't quote enviro mentors - she quotes David Healy, the Welsh physician who settled a claim with U of T after charging they had withdrawn a professorship over his stand on antidepressants. In his own studies, Healy alleges that one in 20 patients will become seriously agitated on antidepressant drugs and one in 80 will become suicidal.
Reps for Organon Inc., the maker of Remeron, admit there are advisories on self-harm in its literature. "The information is very general," cautions Dr. Victoria Davis, director of medical affairs at Organon Canada Ltd. This is true: the warning applies to all antidepressants as a category.
Davis does concur, however, that physicians should closely monitor their patients "regarding thoughts of self-harm or other adverse events. Monitoring the patient once a week or more is appropriate but often difficult with current medical loads.
"Unfortunately, suicide is a side effect of severe depression," she says, after hearing Gomberg's drug history. "His dose being increased suggests the usual dose of 30mg was insufficient."
But are prescribing MDs - more likely to be family physicians than psychiatrists - getting the straight goods from companies about potential harm, or are harsh facts giving way to ad copy? "Drug companies have a lot more influence now than before," says Dr. Joel Lexchin, one of the experts Bischoff relies on at her anti-pharma meetings.
Lexchin, who has spent the last 25 years researching the connection between drug trials and Big Pharma interests, points out that in the early 90s the feds started cutting funds to regulating bodies like Health Canada. Now, drug makers actually fund about half of the regulation process since the feds started billing the industry for expenses.
"There's a perception that since the companies are paying, regulators have to listen to their concerns," he says, on issues like whether a particular advisory might be too strongly worded, for example.
This is the type of controversial knowledge that Bischoff is reinventing her activist mandate around. She intends to return to Alberta - where she and Gomberg founded EcoCity in the early 90s, when Ralph Klein was still only minister of the environment. She will live with her parents, earn no wages and focus entirely on pharma issues.
"I think there's a real need for activists to move into the area of health issues and drugs," says Bischoff, a person with an earnest often humorous manner that belies her focus, resolve and directed anger. "It's a small community of radicals in every city fighting the medical establishment on their own. They're not well networked."
She admits that guilt is a big mover in her own actions, a sense that she could have done more. "I should have been in touch with the doctor. I should have been aware that suicidal thoughts need to be taken very seriously," she tells me. "I'm very motivated to devote my energies to this issue, because I'm so personally touched by it."
Will Bischoff eventually return to the environmental movement? There are, she says, correlations between green issues and her new work, in the exploration of holistic alternatives to drugs, suspicion of corporate interests or even just the need to "take care of ourselves as environmental activists."
It's a high-stress job, after all.