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

 

The Rt. Hon. Frank Dobson PC MP
Secretary of State for Health
Richmond House, Whitehall,
London SW1 15 April 1998

Dear Mr. Dobson,

I'm sorry to trouble you again, but I am anxious to follow up the questions I raised in my letter to you of 2 December 1997 (also in my letter of the same date to the Chief Medical Officer), about the scale and cost of iatrogenic disease in the NHS. To recap: 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 - and, given that about half of all iatrogenic disease is avoidable, shouldn't more be done to control it?

I was prompted to write by the report in today's Journal of the American Medical Association (Lazarou J et al, JAMA, 1998; 279: 1200-1205), a meta-analysis which estimates that the overall incidence of serious ADRs in US hospitals was 6.7%, and of fatal ADRs 0.32% of hospitalised patients. This implies that (in 1994) over two million patients had serious adverse drug reactions, including 100,000 deaths - making adverse drug reactions between the fourth and sixth leading cause of death.

I can think of no reason to conclude that NHS figures would be substantially different, hence the very rough estimate I suggested in the paper I sent you on 12 March. This suggested that "in the UK, each year, prescribed drugs cause a few tens of thousands of deaths, and a few hundreds of thousands of hospital admissions, plus a few millions of sometimes quite troublesome side effects, usually never counted at all." Would the Department broadly agree?

Of course there is uncertainty about the figures but, clearly [a] the problem of drug-induced illness does need to be addressed; and [b] is certainly not properly addressed by the MCA/CSM 'Yellow Card' ADR reporting scheme.

Could someone please now let me know what are the best estimates available in the Department of the extent and cost of drug-induced illness in the NHS? Many thanks.

Yours sincerely,

Charles Medawar

CLICK HERE TO READ ON

Contents page
Correspondence with government