Social Audit Ltd
P O Box 111 London NW1 8XG
Telephone/Fax 44 (0)171 586 7771


Mr. Peter Dunlevy, Executive Support
Medicines Control Agency
Market Towers, 1 Nine Elms Lane
London SW8 5NQ

3 March 1999

Dear Mr Dunlevy,

Thank you for your letter of 2 March, about the incidence of SSRI withdrawal and the CSM/MCA understanding of the significance of the Rosenbaum et al study. I note that you spend weeks consulting your colleagues for advice and end up repeating what you said before - except that you didn't come back to me on the very important point about the long-term efficacy of paroxetine. Was this an oversight, or deliberate?

I also note that your colleagues deny there's a problem with fluoxetine - but then ask what I mean by 'cross tolerance'. If they wanted to know, why didn't you ask? My point about cross-tolerance boils down to this: if fluoxetine relieves withdrawal symptoms from, say, paroxetine - and vice versa - wouldn't you suspect that both drugs were liable to cause problems on withdrawal? OK, there may be different manifestations of withdrawal, but then beer doesn't look much like gin.

Your letter concluded, I thought, on an unduly lofty note, suggesting there was some sort of parity in our assessments of the evidence: "… we will have to continue to disagree …". I wouldn't have put it as high as that: it's not that we disagree, it's that the Agency has no better defence against my questions than secrecy, authority, obfuscation and delay. Your letter exemplified for me two other outstanding characteristics of this dialogue with the MCA/CSM

1. Every time I try to discuss the science, there's a loud whistling noise as everyone goes to ground. The former Professor Rawlins set the tone and Dr Jones has followed suit: roll out Executive Support.

2. The MCA/CSM are constantly on the defensive. Never once have they suggested my/our analysis is incompetent - always they argue that they haven't made a mistake.

If you (MCA/CSM) think there are fundamental flaws in my assessment of the risk - as I am certain there are in yours - I think you have a public duty to say so. The present situation must be quite upsetting and confusing for some patients - see ADWEB Discussion - so if you really believe I'm barking up the wrong tree, you should say so. Until you persuade me otherwise I shall continue to believe the MCA/CSM are incompetent and that patients are getting a rotten deal because of it.

The bundle that Mr Alder sent me at Christmas included a draft, prepared one year ago, of an article on SSRI withdrawal problems, destined for a CSM/MCA Current Problems leaflet. As nothing has been published, I should like to ask if there is a revised draft in circulation and, if so, if I might be allowed to see it?

Yours sincerely,
Charles Medawar



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List of correspondence with MCA/CSM