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The Rt. Hon. Frank Dobson PC MP
Secretary of State for Health
Richmond House, Whitehall,
London SW1

2 December 1997

 

Dear Mr. Dobson

I am writing to you both as a constituent and on a professional matter, an impending health problem with politically sensitive implications. Very briefly, the Medicines Control Agency/Committee on Safety of Medicines seem to be making a ghastly mistake in telling people that tranquillisers like Valium are drugs of dependence, but antidepressants like Prozac not. While relying on research of dubious scientific quality to support their view that all's well, the MCA/CSM are sitting on compelling evidence that drugs like Prozac are quite as 'addictive' as tranquillisers such as Valium, if not more so. The present situation seems to parallel closely the position in the early 1980s when the authorities mistakenly claimed that barbiturates were drugs of dependence, but tranquillisers not; this involved the previous government in litigation and related problems which lasted for years. The enclosed press release and paper spell it out. I would hope that the evidence in the paper would allow your advisers to give you one word (maximum one line) answers to these questions:

Is there a serious risk that Prozac will prove as much a drug of dependence as Valium?

If so, would you anticipate a drug 'drama' or 'crisis' of significant proportions?

Is there a real risk that this case could scupper government proposals to curb legal aid?

Does this case raise doubts about the competence and/or integrity of the MCA/CSM, such as to suggest the need for a formal and fundamental review?

What is the Department's best estimate (ballpark figure or range) of the cost to the NHS of injury from prescribed drugs taken with therapeutic intent, expressed as a proportion of the national drug bill?

Given that about half of all iatrogenic disease is avoidable, shouldn't more be done to control it?

Over the past four months, I have been in correspondence about this with the MCA/CSM but have become, if anything, more concerned as a result. Frankly, I would be astonished if you were reassured by any of the answers to the above questions, also dismayed to imagine you might be advised that professional intervention alone might make the issue go away. This could not be satisfactory, since too many of Department's professional advisers would themselves be implicated in the making of the problem.

Not least because your government has inherited this problem, I very much hope you would resist any advice to take it on and tough it out. A cover-up would surely not be the softer option in this case. It could mean government becoming embroiled in a protracted, high profile drug drama with, I think, an exquisitely high risk of being found out - also being seen to be too much influenced by commercial imperatives and not concerned enough about health.

The Prime Minister has emphasised 'coming clean' as a hallmark of good government and surely this more honourable course would also prove the most constructive, the best way of containing patient and consumer concerns. I respectfully suggest, as a possible way forward, a response which makes a commitment to review publicly the medicines control system with a view to reducing iatrogenic disease, focusing in particular on [a] the need for transparency and better communication; [b] the need for active participation by consumer and patient representatives; and [c] avoidance of conflicts of interest within the Department and for individual expert advisors. I have in mind here the conflict between Departmental sponsorship of the pharmaceutical industry and effective stewardship of the NHS, as well as the close links between pharmaceutical companies and most individual members of the Committee on Safety of Medicines.

By addressing these main underlying causes of any 'Prozac Problem', the government would find it that much easier to distance itself from the problem - leaving it essentially to the medical profession to deal with the health issues that might arise. I would be happy to assist in trying to fairly resolve this, and hope you will get in touch if you think I might do so.

I am writing in similar terms to the Prime Minister, the Chancellor of the Duchy of Lancaster, and the Chairman of the Select Committee on Health. In the near future, I shall also be posting this paper and all correspondence arising on the Internet. Protocol-wise, I admit this is pushing it but, if I correctly understand what New Labour is seeking to achieve, I know you will not remotely regard this as an unwarranted exploitation of my democratic rights.

I am very sorry to add to your already appalling workload, and many thanks for your attention.

Yours sincerely,

Charles Medawar

 

4 December 1997

 

Dear Mr. Dobson

MEDICINES CONTROL AGENCY AND SSRI DEPENDENCE PROBLEM

I am enclosing a copy of the letter I have today written to Dr. Keith Jones, Director of the Medicines Control Agency, arising from the MCA statement sent by the Department yesterday to The Times.

Mistakes of exactly the kind I warned of in my letter to you of 2nd December have already been made. However, it is not too late to repair the damage done, though it very soon will be. I do hope you will feel able to intervene, if only in the interests of a more peaceful weekend.

Yours sincerely,

Charles Medawar

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