Colin's Blog

In February 2007, Nevres Kemal, a Haringey social worker in London, wrote to the then health secretary, Patricia Hewitt telling her that the London Borough of Haringey was failing to protect vulnerable children. In November 2008 in spite of 60 contacts between a Haringey baby (baby P) and Social workers in the eight months prior to his violent death what government had been warned of happened. Kemal’s lawyers had also apparently written to three other MPs including Rosie Winterton then Minister of Health. The MPs were warned, according to the Daily Mail, that there was a risk of a repeat of the Victoria Climbié case, the eight-year-old girl who was murdered in Haringey in 2000. No action was taken by any minister. What they did do was pass the letters on to another department.

Rose Winterton has form and has been a key player in the tranquilliser scandal. Successive governments have allowed tranquilliser damage to continue to blight lives, but the Labour government which took office in 1997 is the first administration to make denial an art form—it is an administration quite prepared to swear black is white. Rosie Winterton has been part of the denial.

In October 2003, Professor C.H. Ashton, Jim Dobbin MP, John Grogan MP and campaigners, met Rosie Winterton. They outlined the impact of benzodiazepines and explained that there was no help available in withdrawal for patients made dependent by doctors. Barry Haslam, a victim of Ativan, who runs a voluntary support group in Oldham and who has campaigned for years, distinctly remembers her looking very surprised and declaring that she had obviously been misinformed. This seemed positive for a while, but when the written reply came from the Department, the traditional position remained unaltered. What had happened after the meeting? Had Rosie Winterton really been surprised? Did she really feel she had been misinformed?

The Department of Health has never (in spite of its assertions) wanted to know anything about the real scandal of benzodiazepines. Withdrawal from benzodiazepines is not the relatively simple matter the Department of Health maintains it is.

The following are examples of letters which have passed between benzodiazepine campaigners and the Department. It should not take too long to construct an understanding of just how seriously the Department actually takes the ‘problem’ of more than a million prescription addicts and thousands of ruined lives. The Department of Health and its agencies have recognised for nearly thirty years that the drugs are ineffective in the long-term, and for nearly twenty years have acknowledged that they cause addiction and impact on health. During that period, a way of controlling prescribing, which has continued in spite of ‘guidance’, has somehow never been found and the victims have never been acknowledged.

The first of the letters is a written submission to the Department, by Professor C.H. Ashton.

Submission to Department of Health from Professor Heather Ashton, DM, FRCP, October 14 2003
Meeting attended by Rosie Winterton MP, Minister of State, DoH, Phil Woolas MP, John Grogan MP, Jim Dobbin MP

There are still about one million long-term, prescribed benzodiazepine users in the UK. Our own survey in Newcastle found an average of 186 such patients in every GP practice. Similar figures have been obtained in surveys in Gateshead, Liverpool and other UK general practices.

These patients, taking prescribed benzodiazepines regularly for six months, a year, often many years, have become dependent on the drugs through no fault of their own, yet they receive little medical help or advice. Almost daily I receive letters, phone calls and emails from such people who claim that they get scant support from their doctors and almost none if they wish to withdraw their medication.

In fact benzodiazepines are still affecting people at all stages of life, from the elderly who take them chronically as sleeping pills or are given them to keep them quiet in retirement homes, to young and middle-aged patients still being prescribed potent benzodiazepines such as Ativan for long periods, to psychiatric patients discharged into the community, still taking benzodiazepines started in hospital, to women being prescribed during pregnancy and thus their developing foetuses and newborn infants. And finally this over prescription has led to benzodiazepines leaking into the illicit drug scene—there are about a hundred thousand so-called "recreational" benzodiazepine abusers in the UK who take the drugs illegally (with all the health and social risks of polydrug abuse, including hepatitis and HIV), and this number is growing rapidly.

I ran an NHS benzodiazepine withdrawal clinic in Newcastle for 12 years from 1982–1994. The success rate for withdrawal was nearly 90% and the patients' physical and mental health improved. But when I retired, this clinic closed, along with other dedicated NHS withdrawal clinics throughout the UK. As far as I know, there are none left now. Some benzodiazepine dependent subjects have been diverted to "detox" units designed for alcoholics and users of hard drugs, but such clinics are highly unsuitable for benzodiazepine patients. Other patients are simply left to fend for themselves or to attend charities and self-help groups which receive little public funding.

It is a well-established fact that long-term benzodiazepine use leads to physical and mental health problems. In addition there were 1810 deaths from benzodiazepine overdose 1990–1996 according to Home Office Statistics and there are an estimated 1600 benzodiazepine-related traffic accidents with 110 deaths each year in the UK.

There is a regrettable paucity of available treatments for such patients. This is partly because many doctors have not heeded the advice of the Committee on Safety of Medicines, circulated to all doctors in 1988, that prescriptions should be short-term only two to four weeks, and that benzodiazepines should not be prescribed to patients with depression, and partly because doctors are unsure how to handle benzodiazepine withdrawal, despite the sound advice available in the British National Formulary that all doctors receive.

The only contributions I have been able to make since having by law to retire from NHS practice at the age of 65 is to write the booklet “Benzodiazepines How they work and How to Withdraw” (available free on the Internet), to give advice to local support groups and charities such as the North East Council for Addictions (NECA) in Newcastle, and to answer several hundreds of personal requests for advice.

I submit that there are some minimum immediate requirements for action that the Government could and should take now:

a) The CSM should issue repeat guidelines on benzodiazepine prescription and withdrawal methods to all doctors, and the Chief Medical Officer should also issue a statement to all doctors outlining the problem and providing guidelines for prescription and withdrawal. I would be happy to assist in the drafting of such documents.

b) The Government should provide finance for health workers, such as community nurses and pharmacists and counsellors, to attend GP practices to support patients withdrawing from benzodiazepines. They can supply the much needed regular patient contact that GPs don't have sufficient time for. This approach has already proved successful in some centres but needs to be extended nationwide.

c) The Government should provide grants to support groups such as Council for Involuntary Tranquilliser Addiction (CITA), Bristol & District Tranquilliser Project, North East Council for Addictions (NECA), the Oldham Group and others to set up and run benzodiazepine support and withdrawal centres. Many of these groups have more knowledge and experience of benzodiazepine problems than doctors.

These are modest short-term aims. Long-term, research and development of non-drug treatments for anxiety and insomnia is needed, as well as better education of doctors on long-term drug effects. Already there are problems arising with non-benzodiazepine hypnotics such as the "Z-drugs" (zopiclone, zolpidem and zaleplon) which are being prescribed instead of benzodiazepines but are causing the same problems including dependence and abuse.

It is a tragedy that these steps are needed 50 years after benzodiazepines were first introduced. They could have been foreseen and prevented but instead the skeleton was locked in the cupboard for many years. Now we are faced with worms that are crawling out of the woodwork including not only the problems of long-term prescribed users but also the increasing spectre of illicit benzodiazepine abuse.
C.H. Ashton

For an appreciation of the official mind, the reply from Rosie Winterton gives the government response to the request for what most people would regard as the very least that the innocent were due. This second letter is one more marvel of Health Department production:

From Rosie Winterton MP, Minister of State, Department of Health, January 11 2004

Thank you for a very helpful meeting in October to discuss the issues associated with benzodiazepine prescribing and the problems experienced by those who are now dependent. Thank you also for the documents you have supplied.

First of all let me say that the Department of Health, the NHS and the various professional groups regard involuntary addiction upon benzodiazepine drugs as a very important issue. We have taken a number of steps to tackle the problem, and we are encouraged that the number of prescriptions is now falling.

As you know, the main focus of the Department of Health's action in this area has been to try and prevent addiction/dependence occurring in the first place by warning GPs and other prescribers of the potential side-effects of prescribed medicines and the dangers of involuntary addiction. I know you are aware of the advice issued in the British National Formulary (BNF), updated twice yearly and issued free to all doctors, and the advice issued by the Committee on Safety of Medicines (CSM).

In addition, we have commissioned the National Institute of Clinical Excellence to develop a guideline on the management of anxiety. This will include recommendations about drug treatments. I believe we can remind GPs of how important this is by publishing a short note in the Chief Medical Officer's Update and I will ensure that this is done.

At the meeting, the dangers of illicit drug taking and of the operation of a black market in tranquillisers, was mentioned. I understand that a common means of obtaining diverted drugs is by deception of the general practitioners either through plausible exaggerations of daily consumption or multiple registrations with different GPs, commonly as a temporary resident.

As you know, responsibility for prescribing, including the issue of repeat prescribing of tranquillisers, rests with the doctor who has an ethical responsibility to inform patients about the treatment proposed, including any possible side-effects of prescribed medicines. It is the responsibility of the PCT to ensure that adequate controls of prescribing are in place. Conspicuous poor prescribing would result in disciplinary action, either from the PCT or from the General Medical Council. The use of clinical audit and peer review has also provided a powerful incentive for local clinicians to study their patterns of care and improve prescribing standards.

It is the responsibility of the prescribing doctor to try to ensure that any drugs issued are not diverted onto the illicit market. The Misuse of Drugs Act 1971 makes it illegal to supply benzodiazepines to someone else. Provisions contained in the Criminal Justice Bill that comes into force on 29th January this year mean that the maximum penalty will be changed from 5 years in prison and a fine to 14 years. I understand you have concerns about how to change the controls in place relating to these drugs. Of course this is a matter for the Home Office, but I suspect the more promising approach for people who suffer dependence is to ensure there is good awareness among patients, the public and the NHS, and an adequate range of services.

For those who have developed dependence upon tranquillisers, treatment is available in primary and/or secondary care settings. Anxiety management, which may be on an individual or group basis, often includes some focus on reduction or cessation of tranquillisers. Such therapy may be available in Clinical Psychology Departments, via a Day Hospital or from a Community Health Team.

I realize that waiting lists for 'talking treatments' can sometimes be too long. This is why we set out standards for access to treatment in the National Service Framework for mental health and issued guidance to help GPs and service users and carers know more about the effective treatments in 2001. Copies of this guidance are available at:www.doh.gov.uk/mentalhealth.

I acknowledge the point made that advice and guidance on prevention is not always enough, but we have to work with the levers that are available to us. This is why, to strengthen the performance management arrangements in place to support best practice, we recently asked the Commission for Health Improvement (CHI) to consider including waiting times for psychological therapies as one of the Performance indicators for mental health trusts, which is still under discussion.

In addition to this, since our meeting, there has been extensive discussion with CHI about the PCT Performance indicators relating to prescribing. Although I understand you may be disappointed at the outcome, we were persuaded by the arguments made by the CHI and others that we should not restrict our attention to the Benzodiazepine group of drugs alone. We have therefore agreed to broaden the focus and extend this PI to include other drugs such as antidepressants and anti-psychotics as well. Information about this has been placed recently on the CHI website www.chi.nhs.uk.

Last but by no means least I would urge you to contact the National Institute for Mental Health's (NIMHE) Expert by Experience Programme. I would like to see better information available for benzodiazepine users about the scope for supported self help, and about best practice. (NIMHE) is supporting dissemination of information for service users and carers and I believe there may be an opportunity for you to strengthen this.

I am copying this letter to Jim Dobbin MP and Phil Woolas MP and I assume you will share this letter with those who accompanied you to the meeting.
Rosie Winterton MP, Minister of State, Department of Health, January 11 2004

Professor Ashton replied to the minister regarding her sanguine use of statistics, pointing to a fall in benzodiazepine prescriptions. As she says, this is largely due to the vast increase in prescriptions for SSRI antidepressants, and the rise of ‘Z’ drugs, the effects of which are the subject of another struggle by patients, academics and campaigning groups. With her experience, she cannily spotted the attempt by the Department to side-step the real issue by talking about legal penalties applying to patients passing on prescriptions. As she said, helping patients to stop taking the prescriptions in the first place would be more to the point. The Minister did not address the position of the formerly dependent patients who now found themselves apparently permanently damaged, but then why would the Department want to do that? There was no money forthcoming for withdrawal services, so ensuring assistance for the permanently disabled, would be seen as even more of a step too far. This step too far should never be undertaken, in case of wider repercussions and discussion around the purpose of medicine and the effectiveness of drug regulation.


Bridget Prentice MP wrote to Rosie Winterton on behalf of one of her constituents but received a reply from Caroline Flint.

Thank you for your letter of 15 November on behalf of your constituent Ms T. regarding benzodiazepine addiction.

I would like to reassure Ms T. that the Government is committed to ensuring that those people who misuse drugs of any kind have access to services that best meet their needs.

In terms of the commissioning of services available within individual areas, this is the responsibility of the NHS at local level, which is able to commission services based on the needs of the local population.

Turning to the points identified in the advertisement enclosed with Ms T.'s letter, I should emphasise that individuals with dependence on benzodiazepines are already able to access a range of services in primary and secondary care. In primary care, counselling, advice and/or psychological therapy are available. Secondary care services are also available, including specialised mental health services and specialised drug services. NHS services are commonly provided on the basis of clinical need rather than the causes of need, and support for benzodiazepine withdrawal can be provided in a range of settings.

On the issue of enforcing guidelines regarding the prescription and usage of drugs by GP's and psychiatrists, there is already clear guidance available. Any practice outside of this guidance should be brought to the attention of the relevant Primary Care Trust with immediate effect. The Committee on Safety of Medicines (CSM) continues to issue advice regarding the prescription of benzodiazepines, emphasising that they should be used for the short-term relief (2–4 weeks) of severe or disabling anxiety, and not for the treatment of mild anxiety. This advice was reiterated in the Chief Medical Officer's Update in 2004. Given concerns about previous over-prescribing, it is of note that the number of benzodiazepine prescriptions issued in England in 2005 fell to under 12 million per annum.

We have also introduced a new ‘instalment dispensing' facility, for prescribing diazepam in cases of dependence, which enables these to be dispensed by daily or by less frequent instalment. It enables prescribing professionals to use this mechanism to increase the safety of such prescribing should it be necessary. Prior to this being introduced, prescribers had to write multiple short-term prescriptions to achieve this. The facility had already been available for a number of other controlled drugs for use in the management of dependence for some time prior to its introduction for diazepam.
In terms of updating warnings, this matter is kept constantly under review and, should we conclude that further action needs to be taken in this area, we will not hesitate to do so.

I hope Ms T. finds this reply helpful.

Caroline Flint, Public Health Minister, 18 December 2006

Professor C.H. Ashton wrote to both Ms T. and to Rosie Winterton, having been distinctly under-whelmed by Caroline Flint’s assurances.

Dear Ms T.
Thank you for your letter and enclosure.
I see that Caroline Flint rolls out the same old story we have heard again and again from the Department of Health—that individuals dependent on benzodiazepines "are already able to access a range of services in primary and secondary health care". I have pointed out repeatedly to Rosie Winterton and others that this statement is not true. In primary care the waiting list for "counselling, advice and/or psychological therapy" is up to two years, by which time it is too late for the long-term patient to benefit from it, especially since the therapists are ignorant about the effects of benzodiazepines and withdrawal. Secondary health care services are usually not available for prescribed benzodiazepine users; they are regularly turned down because they are not also using opiates or other "hard drugs". Mental health centres and specialised drug services are in any case inappropriate, and often disastrous, for prescribed benzodiazepine users who are a quite different population from illicit drug users. The "instalment dispensing facility" is a gross insult to prescribed users and reflects the hard-headed ignorance of the Department of Health who seem to be concerned only with illicit drug abusers.

Caroline Flint's letter reveals again that the interests of long-term prescribed users are being fobbed off as usual with weasel words that are not relevant to their case.

The side-effects of zolpidem, zopiclone, zaleplon and eszopiclone are the same as those of benzodiazepines, as recognised by the National Institute of Clinical Excellence (NICE).

I enclose a reply to my letter to Rosie Winterton from one of her deputies, and my response. It seems we are up against a brick wall!
Professor C.H. Ashton, 29 January 2007

Rosie Winterton had found herself too busy to reply personally. Instead the Professor received a reply from the ‘Customer Service Centre’. Professor Ashton replied on 29 January 2007.

Dear Ms Spencer
Thank you for the letter you wrote on behalf of Rosie Winterton. The government's aim to reduce waiting times for talking therapies, especially cognitive behavioural therapy (CBT) may be laudable for patients with depression, but it is clear that neither you nor Rosie Winterton understand the issues with regard to long-term benzodiazepines users. As previously explained, talking therapies, especially CBT, are not helpful for long-term benzodiazepine users who are still taking the drugs because benzodiazepines impair the ability to use cognitive strategies as well as impairing judgement and memory.

The first step is to withdraw these patients from the drugs. This requires support of a different kind as I have previously explained at length and will not reiterate here. So quicker access to talking therapies may prevent long-term use of benzodiazepines for new patients but will be of little value to the million long-term prescribed users in the UK—however many “waves” you "roll-out" on a “region-to-region basis."

Whether the subject is vulnerable children or patients addicted by the state, going through the motions and avoiding responsibility is the sole responsibility of government.

“British accountability means that everyone is responsible when things go right and nobody when they go wrong. Success has a hundred fathers, failure is an orphan.”
Simon Jenkins, The Times, 4.11.07

“Logic has never held much sway in an organisation that for some has acquired quasi-religious status.”
Nigel Hawkes, The Times, June 30, 2008




At the end of October 2008 it was revealed in the Daily Mail that a woman of 25 had two years left to live and was dying of terminal cervical cancer. She might well not have been but she was denied NHS smear tests three times because she was considered too young. Women in England were previously eligible at 20 and are still eligible for screening from 20 in Scotland and Wales. But in England the policy changed because the risk of cervical cancer in younger women was said to be negligible. In these countries for example, smears are available when girls become sexually active and there is no ‘too-young’ syndrome: Australia, New Zealand, Germany, Canada, USA, Finland but not in the ‘envy of the world’ English NHS(sic).

The woman had asked for a smear test when she was 19 and at University but was told she had to wait until she was 20. She went back at 20 and was told the age limit had changed to 25. She had no symptoms then and was just taking what you might think were sensible steps to safeguard her health. In March 2008 when she found she did have symptoms, cervical cancer was found. She had a hysterectomy, radiotherapy and chemotherapy but in January was told the disease had spread and nothing more could be done.

In 2005 66 women between the ages of 15 and 24 were diagnosed with cervical cancer but a Department of Health spokesman said there were no plans to review the policy as cervical cancer was 'very rare' before the age of 25. This is the usual nonsense from a failed Government Department. It is far more likely that the policy is a cost saving measure rather than a science-based decision. How sadly typical of all things British this is - a totally frigid medical profession, and a government which pays lip service to the well-being of its citizens. For the government and hence the NHS, all that matters is money – to promote its own existence and follow its own agenda. This case and the cases of 66 other women in 2005 are statistics and of no importance - their lives only worth something to them. Obviously, the only answer if you are worried is to go private, thereby paying twice. It is a very sad state of affairs in this country that you pay for a health service but don't receive it in so many areas.
,
The truth about the NHS is that it was a political creation and has been controlled by politics and the Treasury ever since. It is paid for by the citizen (and he has no choice) but it is the politician, the quango, the bureaucrat, the government agency and the government adviser who decide what it will look like, what will be provided, where it will be provided and to whom. Those who pay for its existence through taxes have no say. Many people owe their lives and improvements in health to those working in the NHS but equally many do not.

Reform in Britain occurs not when legislators decide but when a particular case achieves mass publicity and concerned people launch a campaign for change. Perhaps one day this will happen with cancer smears or with prescribed benzodiazepine damage - though with the latter at least it is a big perhaps. The dead hand of Westminster always holds sway until it is twisted by public demand. Unfortunately there have been fifty years for this to happen with benzodiazepines and so far there have been no media campaigns and no long–standing and effective campaigns by individuals or charities, hence no effective pressure on government to acknowledge its responsibilities and initiate change. The lady with avoidable terminal cancer and the millions of innocent victims of a government drug policy have a lot more in common than it might at first appear.


Comments

“I had to see four Doctors to get my first smear test when I was 19 because they all refused to carry out the procedure until I was 25. My first smear showed pre-cancerous cells on my cervix, if I'd had to wait until I was 25 I would have had cancer like this poor lady. Women should be allowed to have the test whenever they request it. Not everyone is as lucky as I was.”

“My friend died from cervical cancer this year, at the age of 24, because she only found out when it was too late that there was a problem. We all went along to the doctor to request smear tests, were all refused, and now another of our close friends has been diagnosed following tests for a separate problem. How many under-25 year old girls have to go through this before they will lower the age? We've all been paying tax since we were sixteen. We deserve better care than this. I think it’s absolutely disgusting that the NHS are playing God with peoples lives.”

Once someone (a person, institution or establishment) starts to lie to avoid responsibility, they can't and won't stop, lest everything unravel. That is why the Department of Health has never taken the plight of thousands of benzodiazepine victims seriously or prevented medicine from creating them.

Politicians like to trumpet how bright and talented doctors are. The truth is, there are very few that would qualify for that description – they do not understand the politics that underscores modern medicine. Doctors at every level from humble GP (salary £104,000 a year) to regulator in chief, when it comes to understanding the machinations of government and Pharma and the ethics of medicine, are at best intellectually naÏve and in many cases appallingly stupid (the stupidest usually being arrogant moreover). Pharma understood how naïve and self important doctors are from the first and its greatest orchestrated work was the hugely successful Profit from Medicine Oratorio (also known as The Great Benzo Hymn) with a more modern but as yet smaller choral work for massed choirs The SSRI in D minor.

The culture of ‘Our friends in Pharma know best’ has made the compromised mediocrities in drug regulation think that by ticking boxes, parroting the phrase risk/benefit or sitting in front of a computer screen, they're doing a scientific job. The notion of actually thinking about what patients are saying - indeed the very ability to be able to think about what they say - is alien to most in medicine.

Effective medicine safety can only be measured and calibrated in terms of human beings. Everything in medicine should be adjusted for people first. The illusory numerical analyses of the MHRA that inevitably put numbers ahead of people and degradation ahead of compassion in a caring world would be abandoned.

If medicine is legally allowed to do something it will do it regardless of morality, if it inflates and maintains its status. The only way to ensure ethics and guidance are adhered to is by the use of the stick and not continuing uncritical admiration. The only way to do that is through the law. Prescribed drug victims have been all but excluded from the law.

With every UK Nationalisation and that includes medicine the Hydra Headed vested interest has risen anew..." What about my interests/status/income" The ‘my interest’ elements always demand their pound of flesh. The NHS only came into being because as he said later, Aneurin Bevan bought hospital consultants by "stuffing their mouths with gold". But so that the gold standard did not depreciate, doctors still demanded the right to maintain a register of private patients and nobody outside medicine (but part of the establishment) has ever done anything to stop it.

The Zeitgeist film The Corporation should be compulsory viewing for all in medicine. Perhaps they might then acquire an inkling of what the root of the undeclared war between injured patients and medicine is. The problem is in the legal status of corporations. Over time, their outlook and philosophy become inexorably and inevitably more and more psychopathic because they are treated by the law as a person, have the rights of a person, and yet do not have the moral outlook of a normal person. But medicine believes everything these amoral entities pronounce on drug effects (whatever is known about their previous activities) while side-lining everything that patients (the reason for medicine) say about their negative personal experience.

"So, the ideal is a firm, which is honest and clever."
"Yes. Let me know if you ever come across one."
"Yes, Prime Minister", Series 2, Episode 4, "A conflict of interest"

Do you really think governments and states exist to protect your interests? No, they exist to protect their own class-interests. Nation states were born from conquest, and they have been self-protection rackets ever since, maintained by whatever brand of government was in power at the time. Since the NHS was created by politicians it has been politically defended from criticism and the reality of its mistakes. Medicine became an arm of government after the creation of the NHS though you won’t find any doctor, local health authority or drugs regulator understanding that fact.

What makes anyone think that the world has changed all that much over history? The common man has forever existed to be exploited in some way. In the last fifty years the exploitation has come from a new modern direction – drug companies with the complicity of medicine and politicians. In the developed world we have more of everything material but there is still exploitation. Democracy is a sham when so many people can be destroyed by over-sold and under-researched drugs with no hope of justice. The media are largely complicit in the political propaganda, indifference and cover-up of the Great Benzo Scandal. The egregious actions of a few have always affected the masses. If a system of medicine control exists today where great damage can be done to the innocent it ensures that the damage is carried out. Where there are no consequences for those involved they will never feel a sense of urgency about ensuring that their activities are proper and measured and in the public interest

Communicating with Patients about Harms and Risks [excerpts]
Andrew Herxheimer, emeritus fellow of the United Kingdom Cochrane Centre, Oxford, United Kingdom.

Published: February 22, 2005
DOI: 10.1371/journal.pmed.0020042


A clinician who recommends an intervention does so in the belief that its benefits outweigh the harms that it can cause. In most consultations there is little time in which to explain in detail what these benefits and harms are, or to find out what the patient thinks about them. Moreover, most clinicians are not trained or practised at describing and explaining benefits and harms clearly to patients, and much of the time they also lack important information about these aspects.

Risk Versus Harm
The problems begin with the word “risk”. Very often people use it when they mean “harm”, and this causes ambiguities and confusion. The widely used expression “benefit/risk ratio” is meaningless—no such ratio exists.

The Four Dimensions of Any Benefit or Harm
1. Its nature, described by its quality, its intensity, and its time course (onset, duration, and reversibility).
2. The probability that it will occur.
3. Its importance to the person experiencing it.
4. How the benefit can be maximised, or the harm prevented or minimised.

Details of dose–response relationships are hardly ever published. They are usually studied early in the development of a drug in a relatively small number of volunteers, and are used to decide on the dosages to be used in the major clinical trials that will support the licensing application. They are regarded as internal working data of the company, which is not interested in publishing them. Regulatory agencies do not appear to ask for them or examine them critically.

Reliable information on harms is for several reasons even harder to get. Far less research is done to investigate them. Companies do not want to do more work than regulators require, and once they have marketed a drug they hesitate to pay for more research, especially if the results might be inconvenient. Independent public funding hardly exists.

Effective communication about harms and risks is an essential component of care, and it requires learning, preparation, and rehearsal. The onus lies with professionals to persuade and to teach patients to play their part in coming to an informed decision about treatments.

There are today between 1 and 1.5 million patients addicted by doctors to tranquillisers and hypnotics over the last fifty years. How many of these patients were warned, consulted and helped?

I received a letter the other day from Jayne which described very well the problems tranquilliser victims face when dealing with others. My reply is below.

13 October 2008


Dear Jayne,

Thank you for the letter, I read it with a great deal of interest. There are two truths which most of us fail to recognise and do not understand the significance of:

1. Politics is primarily about public order and government financial security. Anything that threatens that is denied and actively worked against. The benzodiazepine scandal threatens both those things in the mind of government. They are terrified that disclosure would destroy the reputation of the NHS and the prescribers who work in it. They are also terrified of the political backlash that might occur if the facts were known. They believe that the costs of compensation would be so enormous as to be unthinkable. Lastly they are aware that the regulatory system as it exists would be gravely threatened if it became public knowledge that they have failed to protect so many people from the rapacity of drug companies and the ignorance of prescribers over so many years.

2. Most people, even those close to us can’t grasp the enormity of it all even when presented with the facts. We exist with a system of beliefs which provide us with a secure picture of the world and we really try very hard to avoid those beliefs being adjusted or torn apart. Most human beings do not seem to have the capacity to recognise a scandal and get involved on a personal level - they cannot grasp that a drugs provision system which produced the great benzo scandal, if it is not altered, will produce another and it might then affect them. In recent times we have had Vioxx and of course SSRIs but even the latter is not on the scale of tranquillisers. But for tranquilliser victims it is chillingly obvious that the same defences are being erected against the victims of anti-depressants – it is like watching a rerun of an old and well-known drama. Family members find tranquilliser withdrawal incredibly stressful and wearing. They have their own lives and concerns and either find it impossible to believe that medicine can act in the way it has or they simply run out of the ability to keep on listening. Deep down they believe falsely that they would never have found themselves in the situation you found yourself in, that somehow you must hold responsibility for what happened. If you are a campaigner as well as a victim they may also believe you are mad to continue your efforts on the issue – why can’t you let it go and move on they ask. For peace of mind, moving on is the most sensible thing you could do, it keeps your blood pressure down and leaves you with more energy. Benzo victims who are also campaigners do what they do in the face of great odds, their health is shot, they face indifference (and know it) and they may also be in straightened financial circumstances. But they feel if they do not do it, there will be no change and having experienced the reality of medicine at first hand, they know things must change.

I think there is something in the human psyche which shrinks from things seen as abnormal – we do not want to be told about it and we do not want to associate with it if we can avoid it. There is little stranger than the Benzo victim like a stuck record repeating the same things over and over. The victims are not aware they are doing that, they are merely trying to describe symptoms which in the normal run would not be part of human experience. They are trying to make sense of something which in essence has no sense attached to it. That medicine which is associated in the public mind with science and caring has turned so many people into uniquely sick individuals is unbelievable – if it hasn’t happened to you. There is for a long time a tendency to blame yourself – in a strange way it is far easier to do that than blame somebody else and even when you have a good grasp of the real picture, you still find yourself doing it from time to time. The questioning look in the eyes of others is pretty hard to deal with and is bound to make you question your own experience. People and particularly sadly even doctors and pharmacists would rather see you as disturbed than question their own beliefs.


These quotes are relevant I think:

“We do not like those who unmask our illusions.”
Ralph Waldo Emerson

“Rob the average man of his life-illusion, and you rob him of his happiness as well.”
Henrik Ibsen

“I have spent over thirty years studying the world of medicines, and regret to say that the more I learn, the more shocked I feel. For all the triumphs and miracles, I fear that we are heading blindly in the general direction of Pharmageddon.”
Charles Medawar, Social Audit.

"If any drug over time is going to just rob you of your identity and be an ironic reaction to early effectiveness [leading] to long, long term disaster, it has to be benzodiazepines."
Dr John Marsden, Government Adviser on Drug Addiction

“I am an eloquent scientist, but even I did not think to question his [the doctor] advice. I assumed the drug was no big deal and would just help with my difficulty in sleeping. I had no idea it could be mind-altering and cause a serious addiction.”
Professor Jane Plant CBE, Chief Scientist British Geological Survey


Claud Cockburn the father of Independent journalist Patrick Cockburn once said, “Never believe anything until it’s officially denied.” The great benzo scandal has been denied, minimised and avoided so many times by medicine and by politicians that it has to be true. You and I have been a part of it.

All the Best

Colin

As long as people believe in absurdities they will continue to commit atrocities - Voltaire

There is a way to ensure that groups of individuals, all suffused by the same culture, serve the public good and not just each other and it is to make them accountable to a much larger group of people, each with a different view of the situation - in other words, democracy. The government drugs advisory industry and indeed politicians themselves could not stand out against a far greater number of people who had been informed of the benzodiazepine scandal and wanted something done about it.

Democratic accountability is infinitely superior to allowing professions such as medicine or politics, effectively to deny and distort logic and withhold protection from citizens .

Independence of the medics is misplaced in the known context of drug company shenanigans and is one of those establishment-serving fictions beloved of politicians who want things to be kept at arms length in case things get awkward. And in a democratic society, things would certainly have got very awkward for successive generations of politicians who watched and denied while the ignorance of medicine and its regulators turned well people in sick people and took away their human rights to pursue relationships and a normal economic life.

It is, according to behavioural scientists, a need to be with people who are like us that makes us join up with others whom we sound like, have the same interests and a similar background. That is why politicians, prescribers and drug regulators sing from the same hymn sheet in the face of mountains of patient evidence that there is something terribly wrong with the way drug companies, prescribers and regulators behave. Everyone is misguided but them.

People co-operate with and support those who are not family members because in evolution that co-operation has been a successful format. Working with people who will return favours and co-operation is a strategy that has produced successful outcomes. In partnership, politicians, drug company executives, prescribers and drug regulators have in effect competed with the interests of patients, interests, which in reality are not seen as their own, whatever they say or believe. In order to create and maintain groups that can be trusted, those who cannot be trusted are excluded – and that means as far as drugs are concerned the patient client base, the one group of people in society with the experience to judge independently. The health establishment conforms like all common interest groups to group norms, sounding pretty much alike and producing the same self-serving message. Whatever happened, if it was a negative experience - you the patient are responsible for it.

You got a lotta nerve
To say you gotta helping hand to lend
You just want to be on
The side that's winning

I wish that for just one time
You could stand inside my shoes
And just for that one moment
I could be you

Yes, I wish that for just one time
You could stand inside my shoes
You'd know what a drag it is
To see you

Positively Fourth Street Bob Dylan


It’s all in the mind. It’s part of the illness. These routine expressions of medical ignorance illustrate the deeply unprofessional and quasi-religious belief system endemic in medicine (particularly among psychiatrists). This system rises from a well of ignorance masquerading as expertise which was built, is maintained and is controlled by pharmaceutical companies, where nothing is wrong but the patient. As someone said to me a couple of days back, it results in euthanasia, by another means.

We are talking here about the reactions of medicine to mental ill health and subsequently reported symptoms. More than that, we are also talking about the active creation of mental ill health by medicine and the consequent symptoms.

Once psychological labels have been applied to an individual, in medicine it seems, any symptom reported thereafter by that individual is liable to be dismissed as part of the illness and fictional. The real truth is that many of the real symptoms reported have been caused by the drug(s) prescribed and even where not, the focus of medicine remains focused firmly and narrowly on the psychiatric and the physical is ignored.

There is no demonstrable science behind much of what medicine declares to be fact and believes about psychiatric drugs - it is received wisdom from a group of global companies whose main purpose is the making of money - corporate psychopaths as Dr Robert Hare describes corporations.

On 3 October 2008 there was an article in Medical News Today:
http://www.medicalnewstoday.com/articles/124095.php

The article declared:

“New figures were released today by the National Treatment Agency (NTA) for Substance Misuse which show that more than 202,000 people were recorded in drug treatment for 2007/08 with the number of people completing treatment successfully in 2007/08 increasing to more than 35,000 compared to 27,500 in 2006/07.”

It also said something which benzodiazepine campaigners have been at pains to point out to government for many years without any acknowledgment that it is true:

"In addition it's worth pointing out that these figures only relate to illegal drugs, while there are way more people addicted to legal and prescribed drugs. There are an estimated 5 million people addicted to alcohol and a further 10 million addicted to cigarettes and 1.5 million addicted to benzodiazepines tranquillisers. Even more may become addicted to certain anti-depressants and non-benzodiazepines but, on the whole, these people aren't being offered effective help.”

How scandalous it is that medicine has been quite prepared to addict innocent patients (many for decades) with tranquillisers and hypnotics over fifty years, and ignore or reject the physical and mental consequences of doing that. How scandalous it is that the Department of Health has placed in the mouths of succeeding ministers a false concern for the fate of these patients and a disingenuous message that they ‘take the problem seriously’. How scandalous it is that a dangerous drug can, in spite of every attempt to illustrate its dangers, claim new victims year after year because of the way it is prescribed and a lack of controls.

There are no dedicated facilities to help with benzodiazepine or SSRI withdrawal and hardly any finance available to carry it out. In the meantime half a billion pounds a year is poured into the illegal drug withdrawal machine. There is something seriously wrong with a society many claim is civilised, which allows hundreds of thousands to be sacrificed on the altar of drug company medicine and refuses even to acknowledge that it does it.

In an article on 5 October 2008 in The Independent entitled Ignored: the mentally ill killed by drugs that are meant to help them, an attempt was made to describe how psychiatric drugs produce severe side-effects and how many doctors as a rule of thumb disbelieve and ignore the symptoms. It described how people with mental health problems die on average ten years earlier and how obesity, diabetes, certain cancers and heart disease are far more common among people taking psychiatric drugs. A recent survey by the charity Rethink found one in five people with mental health problems had had their physical health concerns ignored by their GP in the past year, while one in four felt their doctor was the greatest source of discrimination in their lives.

How much more of a scandal is it when people who were not mentally ill and who were prescribed benzodiazepines then became mentally incapacitated and had the multitude of physical symptoms which can emerge as a consequence denied by the prescriber, presumably because they were not in the drug company list of symptoms?

That medicine is more dangerous than drug companies say it is, is becoming clearer by the day, but not to governments it seems. In a recent report commissioned by the FDA advisory Science Board the chairman of pharmacology department at the Pennsylvania School of Medicine said:

“We were shocked at the appalling state of science at the FDA.” Standards of safety and efficacy have reached a point where drug reviewers “can end up approving almost anything.”

Regulators here and abroad have been doing that for decades, it is merely becoming clearer for more to see.

“The scale of the [benzodiazepine] problem is so large...that it is beyond the grasp of many politicians and people in power to solve it. I think there’s a paradox here, because you have this huge problem with a huge number of people involved, and yet we seem as a society to be incapable of acting on it. We can only cope with problems that are so big...we can’t cope with this one.”
Phil Woolas MP, Local Government Minister,
Croydon Conference, 2000


On October 1 1960, two doctors, Ingram and Timbury, of Southern General Hospital, Glasgow, wrote to the Lancet. They said:

"A new tranquillising drug, (Librium), is now available commercially. It has been widely advertised in terms of its taming effect on wild animals and claims have been made that it is of special value in controlling phobic and obsessional symptoms in psychoneurosis although the published evidence for this is slight.
Nine outpatients with phobic anxiety states and six with obsessional neuroses have been treated with this substance for three weeks. The dosage given was 10mg thrice daily for the first week and 25mg thrice daily thereafter. Only three of the nine phobic patients and one of the six obsessional neurotics felt any subjective improvement. Side-effects were seen in over half the patients. Two felt drowsy on the smaller dose, five on the larger. Two felt fatigued and apathetic, and dizziness and constipation were reported. One patient felt more energetic and two complained of severe irritability. After taking the drug for a week a schoolteacher struck his wife for the first time in the twenty years of their marriage. Of the fifteen patients, three had to stop work because of the side-effects and two others refused to continue taking the drug after two weeks.
Although the number treated is small and the findings uncontrolled, the results are disappointing enough and the side-effects sufficiently troublesome to deserve attention. Other side-effects reported in trials in the United States have included dissociative reactions, hyperactivity, and ataxia.
We feel justified in suggesting that the drug should be used with circumspection and scepticism until the results of controlled trials are available."

In the years following this report, prescriptions for Librium and its successors reached astronomical proportions, peaking in 1978 with nearly 31 million. Such has been the attention paid to those who were not hypnotised by the pharmaceutical claims of wonder and benefit.

Imagine these headlines:

‘DOCTORS TURN WELL INTO SICK
WITH TRANQUILLISERS SHOCK!’

‘DOCTORS KILL THOUSANDS
THOUSANDS MORE UNABLE TO WORK
FAMILIES IN DESPAIR!’

No one has ever seen these headlines, but they should have—such headlines would have been more than justified. Stories have appeared in the print media for many years—most in the local press, but none have examined the political backdrop to the occurrence and continuance of the injury to patients and their families. Instead the media has preferred to follow the human interest line, concentrating on the experiences of suffering of individuals. At this level they did provide a warning (for those who read them), but in the surgery, faced with a doctor telling them that it was all media hysteria, many who would have known better, unfortunately succumbed to this positive medical assurance. This added to the ever-growing number of casualties. The media coverage made no one aware that behind it all was an unexamined situation where the pharmaceutical industry controlled vital aspects of drugs regulation, political action and information to doctors.

The BBC and Independent broadcasters have explored the issue in programmes with titles such as ‘The Tranquilliser Trap’, or even ‘Killer Pills’, but these too did not reach the conclusions they might have reached. Again they concentrated largely on the personal story angle and levelled far too little criticism at the Department of Health, drug companies and the medical establishment.

The BBC expressed astonishment that the DoH had no figures on addiction levels and that doctors routinely ignored the regulatory guidelines, issued in 1988, on safe prescribing. What they did not do was explore the reasons why guidelines were being ignored, or why it had taken nearly twenty-five years to issue them. The question of why the guidelines were issued has never been asked—what research evidence they were based on and when this evidence was produced. They did not express incredulity when government declared itself unable to control events in any direct way. They did not question the assurance that addiction withdrawal is not really a difficult problem, when in fact for many it is as much a horror story as it is with SSRI patients today, often taking years, with no assurance of complete recovery. One contributor expressed this aspect clearly in a response to ‘The Tranquilliser Trap’:

“Why don't any of the programmes...on the subject of Benzodiazepines shown on the television tell the story of those/us that are left with the horrendous withdrawal effects for years after full withdrawal from these drugs?...Why doesn't the programme that you portray as supposedly for and to help the people of this country show the devastation caused by these drugs and not the pathetic description of addiction that was shown last night on your Panorama programme?”

No broadcast or print story has ever insisted that government explains how it reconciles what patients tell it about withdrawal horror with the fact that it has not seen fit to provide crucial support for those affected, and why it prefers to pretend that what exists is adequate and effective. No examination has asked why tranquillisers are illegal drugs outside the surgery, or why they are Class C drugs, when less harmful drugs rank higher on the drug classification scale. Programmes and print media, with the exception of a 2003 piece in the Observer, called ‘Unhappy Anniversary’, have never sought to discover what the standard of the science that led to the licensing of the drugs was, whether addiction potential was studied, or whether there had been long-term studies to determine the consequences of long-term prescribing. Significantly, no one has ever explored the disparity between the experiences of tens of thousands of patients and what doctors believe about the drugs. Why, after nearly half a century, have no details of any controlled trials been released to the general public? Why will the Department of Health not fund clinical trials into the claims of damage of long-term benzodiazepine addicts and former addicts, affected as a result of taking the drugs?

The basic question of course is why medicine, which is associated in the public mind with healing, has, with the use of tranquillisers and hypnotics, inflicted such enormous harm to both the health and socio-economic lives of trusting patients. Medicine occupies one of the most crucial niches in society and yet experience over the years of the giant pharmaceutical companies has shown that medicine possesses a unique immunity to the consequences of its actions. Only the patient, it appears, is expected to bear the consequences of drugs, which the government licenses and its doctors prescribe.

Tranquilliser damage was not an accident. American based pharmaceutical companies, principally Wyeth and Roche, brought their marketing skills to bear on all aspects of licensing and doctor information. They controlled regulators through insider contacts, glossy pseudo-science and through the fact that many regulators owed their career positions and influence to their involvement with the industry. When the potential for damage became known through independent research and the observations of a minority of prescribers, they relied on their out-of-balance power in law, and the cowardice and self-interest of politicians who hid their heads in the sand. They relied too on the partiality of regulators, and the inadequacies of regulatory powers. Indeed, politicians, rather than improve the situation, made sure that the damage would continue, by ensuring that redress would be near impossible to secure through legal means. They restricted the ability of patients to take legal action against pharmaceutical companies and neglected to inform outdated legal assumptions about the nature of the damage.

Thalidomide damage ended only because the consequences were observable and undeniable. Psychotropic drug damage is a different kettle of fish. Tranquillisers were marketed as safe and non-addictive. When it became impossible to deny any longer that they were not, government and regulators allowed manufacturers to drip feed supposedly newly found possible side-effects, over years and decades. No government instructed its regulators to examine the science in detail, looking for drug company evasion. No government has ever seen the necessity to provide research funding to examine patient claims. No government has ever insisted that manufacturers held any kind of responsibility. No government has ever veered from the line that doctors always had the best interests of patients at heart, and that by and large they prescribed appropriately—this even while doctors were rejecting safety guidelines and no rigorous science demonstrated long-term safety.

It does not matter whether you live in America, Canada, New Zealand, Australia or any other point of the compass, the picture of drugs’ regulation owing its first duty to manufacturers as its clients, remains the same. This is because politicians have vested interests in the continuing health of the pharmaceutical industry, which was described by Dr Robert Hare, adviser to the FBI on psychopaths, as having all the characteristics of the psychopath. Governments could formulate a system of regulation that works but they do not. In the UK, how regulation operates is a subject that rivals the processes of MI6 or the CIA. Secrecy is a very useful barrier against change.

It is known from government figures (not the Department of Health), that tranquillisers have killed thousands of people, not as many as barbiturates perhaps, but more than enough. Tranquillisers have devastated an untold number of lives—they have destroyed patients, marriages and families. They are often amazingly difficult to withdraw from completely, and the hidden cost to the NHS and to society is incalculable. The addiction has been made far worse by the ignorance and denial of doctors, based not on scientific evidence, merely the absence of regulatory action and the assurances of pharmaceutical companies.

Many tranquilliser addicts have been too frightened to relate growing mental problems to their GPs for fear of being consigned to psychiatric hospitals, too frightened to reduce their intake because they have known that even reduced functioning required the maintenance of prescriptions, too frightened to question the effect of the pills for the same reason. Cocktails of drugs have been prescribed to counteract the unrecognised effects of benzodiazepines—mistakenly diagnosed and treated as new illnesses, increasing the damage done through drugs.

Professionalism and dedication to patient protection does not figure largely in official circles it seems. Not only has government allowed the benzodiazepine situation to continue over almost half a century but it has demonstrated a complete unwillingness to find out the true extent of the problem which it says it recognises and takes seriously. These are questions (among many) it could ask and seek answers to, but does not:

• Benzodiazepine reactions mimic other illnesses so at any one time, how many hospital admissions involve patients taking these drugs?
• Why are Patient Information Leaflets so uninformative and anodyne?
• How many children being given Ritalin by doctors are the children of mothers who took benzodiazepines?
• How many disability benefit and incapacity claimants are on long-term prescribed tranquillisers and hypnotics?
• Recovered alcoholics and heroin addicts, who have also taken benzodiazepines, routinely declare that tranquilliser withdrawal is far worse than any other type of drug withdrawal Why is it that the proponents of the benzodiazepine protocol find it easy to maintain its benefit?
• When it is well known that benzodiazepines can precipitate suicide, aggression and are a serious cause of a variety of accidents, why is it not compulsory to test for their presence in all such cases?
• Why do patients and campaigners continue to insist that withdrawal assistance does not exist?
• Why do doctors banish ‘difficult’ tranquilliser patients from their surgeries?
• Why does the UK legal system effectively prevent a doctor or drug company being sued for the damage they have inflicted on patients?
• Why does drug regulation repeatedly allow medical damage?

It is impossible for anyone to empathise with all the scandals they are faced with in society, still less act on them. Instead we may sympathise but then leave it to those involved, and those whose duty it is to make changes and protect the innocent. It is important, however, to understand that a system which has allowed such enormous damage is a system with a history. It has always allowed drug damage and washed its hands afterwards. It has not, even now, changed in its essentials, and without protest and the signalling of disapproval, it will never change. You may not have been personally involved in the tranquilliser tragedy or in the ongoing antidepressant situation, but if in the future you receive a prescription, you would like to know that the drug really is as safe as it could possibly be made. Wouldn’t you?

”Patients who are addicted to prescription drugs can be extremely manipulative in their efforts to get GPs to prescribe them more drugs.”
Dr Steve Field, chairman of the Royal College of General Practitioners, February 2008

Dr Field, in saying that the Royal College would ‘take on board’ the findings of the APPG, then followed the usual line of avoiding the question of how patients become addicted to tranquillisers in the first place and mitigated any responsibility for doctors by referring to patient abuse of prescription drugs and lumping this together with addiction through over the counter drugs.

These days the purchase of drugs on the internet is emphasised in any report of the 1 million plus iatrogenic tranquilliser addicts in the UK. This is a recent phenomenon, is a complete red-herring, and has nothing to do with the indisputable fact that hundreds of thousands of unsuspecting patients since the beginning of the 1960s were never warned about what could happen to them, either by their doctors, or by leaflets accompanying their prescriptions. Neither were they effectively protected by government and regulators who were consistently and regularly told by campaigners and patients that doctors in the NHS, in large numbers, were ignoring the four weeks advice and were prescribing as they had before.

Medical and government defence of the benzodiazepine scandal has moved through several stages, not necessarily in this order and not necessarily one at a time. Sometimes previous positions are resurrected:

• The drugs are not addictive
• And if they are, it is because of an addictive personality
• Patients ask for them
• Patients bully doctors into prescribing
• The drugs are cheap to provide for government
• Doctors have no time to assist in withdrawal/doctors find it very difficult
• There are no alternatives to pills in UK healthcare
• Aware or former iatrogenic addicts are merely seeking compensation
• It’s all down to defective genes
• It’s all in the past, it was regrettable but we have learned lessons
• Patients abuse the drugs and must be controlled
• Benzo campaigners select their evidence


The view of patients being the authors of their own demise and deluded victims of their own pre-existing psychological condition began with the pharmaceutical companies and the experts who were linked to them. Until 1988 there was no UK regulatory recognition that benzodiazepines were addictive and should be used with caution. There had been a statement in 1980 by the Committee on the Review of Medicines that “there was little convincing evidence that benzodiazepines were efficacious in the treatment of anxiety after four months' continuous treatment.” Since tens of thousands of people before and after were prescribed them for decades, the conclusion you might think is that although they might not work, they were fairly harmless. Large numbers of doctors disbelieved the first and agreed with the second.

But there was evidence, some of it long before 1980 that benzodiazepines were addictive and had severe side-effects—it was merely a case of not proven in the eyes of regulators. Benzodiazepines had from the beginning a large placebo effect on those who prescribed them and those who regulated drugs.

“How the dependence potential of the benzodiazepines was overlooked by doctors...is a matter for amazement and casts shame on the medical profession which claims to be scientifically based...”
Professor C. Heather Ashton DM FRCP, Bristol and District Tranquilliser Project AGM, October 2005

And as campaigner Mick Behan wrote to the House of Commons Health Committee inquiry into the pharmaceutical industry in 2004:

“Most of the benzodiazepines—Valium, Librium, Mogadon, were on the market before the Medicines Act of 1968. These drugs were issued "Licences of Right". The Licences of Right were a registration procedure and involved no assessment of safety or efficacy. Assessment was deferred to a future review by the CRM. Significantly, those reviews did not occur until 1983/84. By then the damage was done, the huge benzo addict population had been created and still exists to this day.”

There has been much learned discussion over the years amongst scientists and lawyers about precisely when doctors should have known about the addiction potential of tranquilliser/hypnotics. They should have known from the beginning, since nearly every chemical that medicine had ever used to influence the mind had turned out to be addictive. But in medicine it seems, until either an overwhelming mass of new independent scientific evidence or rare pharmaceutical company admission alters the view of a drug, damage done to patients and reported by them does not exist. That is the single most depressing fact about this age of drug company controlled medicine—ostensibly for the benefit of patients and the alleviation of suffering—only those with a positive experience to report are believed. If the positive is accentuated for long enough however, it becomes impossible, it seems, to admit what has happened, take direct action to stop it continuing, or help those affected.

“The scale of the problem is so large...that is beyond the grasp of many politicians and people in power to solve it...you have this huge problem with a huge number of people involved and yet we seem as a society to be incapable of acting on it. We can only cope with problems that are so big...we can’t cope with this one.”
Phil Woolas MP, Croydon Benzodiazepine Conference, November 2000

Benzodiazepines became a huge experiment on the population. It is possible but not likely that Roche and subsequent ‘me-too’ manufacturers had no idea at first that that was what was to happen, but their marketing tactics were certainly aimed at expanding the market as wide as sales tactics and permitted control of research information, could make it. The experiment in profit generation without responsibility for human injury, certainly worked and it drew in vast numbers of people who were not mentally ill and who had no organic disease. Subsequently many of them became very ill, many losing homes, families, jobs and future—things which cannot be given back and remain unacknowledged to this day. Benzodiazepines, contrary to the message coming from government and drug companies, were only in the minority of cases prescribed for clinical anxiety—they were as Professor Heather Ashton rightly says, prescribed for everything:

“[Benzodiazepines] have been prescribed for sports injuries, muscle spasms, premenstrual tension, exam nerves, depression, general malaise and much else. Because they make some people feel good at first...these prescriptions tend to be continued long-term.”
Bristol and District Tranquilliser Project AGM, October 2005

The manufacturers have always maintained the line that tranquillisers had invariably been prescribed for clinical anxiety but what degree of anxiety would even justify the injuries that benzodiazepines can inflict? Rather than for clinical anxiety however, tranquillisers have been prescribed, and led to addiction, for everything from the death of a pet to vertigo. The Department of Health has never wavered from the same line too, and has formulated a message of all reported patient adverse effects being caused by a pre-existing mental health problem. In their view such things as brain atrophy, severe muscle and joint problems, gastro-intestinal disturbances, distorted nerve sensations and a whole host of other physical symptoms are produced by some undiscovered (but always undemonstrated) psychological condition. Such assertions would disgrace a fantasy pot-boiler, but are all too readily parroted in the political world of pharmaceutical/medical defence. Government relies on a variety of allies in its denial but above all on the fact that most of those affected never make the connection between their ill health and the prescriptions. Why would they, unless they research the facts—patient leaflets and doctors avoid all mention of serious side-effects; doctors because they accept what regulators and drug companies do not tell them and leaflets because regulators see it as their duty to rubber stamp the crafted pharmaceutical message they contain.

Interestingly, although he made few public pronouncements on the drugs he created, Roche scientist Leo Sternbach always insisted it was not the drugs, but the doctors prescribing them, who were responsible for the damage. He had a point, but the general message simply does not stand up in the real world where the drugs were prescribed. Although doctors over-prescribed and mis-prescribed, for which they were certainly culpable, the sales arms of Roche, Upjohn Wyeth and others with their messages of benefit without side-effects had underscored what they did. No drug company told doctors to prescribe for a limited period in the interests of safety. No drug company warned doctors that the drugs were addictive in excess and for years they fought the truth that they were.

The UK Government will tell you anything it thinks sounds right and seemingly doesn’t care if the statement is obviously bogus and illogical. They will tell you for instance that abolishing parking charges for visitors and patients to hospitals in England, as Wales intended to do in 2008, cannot be done because ‘forcing hospitals to stop charging would breach the Government's drive to cut carbon emissions by encouraging car use.’ They will tell you that their actions on reducing benzodiazepine prescribing have worked, are working and that they ‘take the problem seriously’. That they ignore what the problem is, refuse to help the severely afflicted and avoid thinking about the fact that the problem has existed for nearly 50 years, demonstrates the untruth of what they say. At any time, the Department of Work and Pensions which does not officially recognise most benzodiazepine symptoms and which oversees social security benefits, may withdraw incapacity benefits from the severely affected who do not tick the boxes. Many of those suffering from symptoms which government refuses to acknowledge and which many doctors do not recognise because they have never been told they exist, live in fear of benefit withdrawal, adding a further impact on their lives, beyond the effects benzodiazepine drugs have previously inflicted.

Ministers have no expertise in the work of most departments they find themselves in charge of. Ministers in the Department of Health are no exception. They are therefore reliant on advisers who are deemed to be unbiased and expert. Ministers have no way of estimating how expert and unbiased they are and perhaps no motivation. Such advisers are the ones the minister asks for a view on any issue raised by patients and campaigners. When former health minister Hazel Blears told a campaigner that she believed benzodiazepine activists used ‘selective evidence’ that view would have originated from her advisers. The fact that campaigners know this is not true gives them no ability to demonstrate it.

The existence of ministers gives complete immunity to the flawed beliefs and actions of advisers and civil servants as they act in their name. Advice on psychotropic medicines comes from the psychiatric sphere of medicine—a sphere that it has been said owes its claim to scientific knowledge simply by virtue of its alliance with pharmaceutical manufacturers and their drugs. With some notable exceptions, such psychiatrists have no motivation to divorce themselves from the benefit message of manufacturers whose financial support and influence has often fostered their careers. Advisers are as a rule, those whose involvement with the pharmaceutical industry has propelled them to their positions. They claim to be the holders of scientific ‘truth’ and the Department of Health accepts it, producing policies based on pharmaceutical company ‘expertise’ and ‘evidence’.

But the truth is held by patients and not science. Ray Nimmo said recently on withdrawal from benzodiazepines and their consequences:

“I swapped depression, anxiety, paranoia, agoraphobia etc for physical symptoms - damage which I now know is permanent. Fifteen years of abdominal muscle spasm resolved on stopping only to be replaced by muscle pain elsewhere. Muscle problems do seem to be a common feature as well as sensory, gastro trouble as well as some anxiety/depression and cognitive impairment. We all seem to be left with something. Heather Ashton says in all her years she heard from only one person who said they had no symptoms. I heard from one... but she was put on a stew of ADs, APs and an assortment of other meds. The first ten years of insomnia were worst for me - improved lately if I resist the urge to nap. Not easy though and I often give in.”

“Every man is guilty of all the good he did not do.” Voltaire

"In England justice is open to all - just like the Ritz."
19th-century legal comment often attributed to Sir James Mathew

False rhino syndrome is the willingness to believe that something is other than what it is...
Human beings possess a vast capacity for misperception and for preferring to believe what they would like to believe...It is difficult to understand politics unless one grasps how ready people are to believe things that are belied by the facts.
Martin Kettle, The Guardian 31 May 2008



It is the custom in the UK parliament to refer to all members as honourable and ministers in charge of departments as right honourable.

The Right Honourable David Blunkett has been a Labour MP since 1987 and in government held two appointments very relevant to doing something about the great benzo scandal. He was Home Secretary from 2001 to 2004 when he was forced to resign after a scandal and was then appointed Secretary of State for Work and Pensions after the 2005 General Election.

In November 2005 he was again forced to resign over business dealings.

The motto of the Home Office is ‘Working together to Protect the Public’. That Department is responsible for drug classification in the UK and in spite of the best efforts of campaigners benzodiazepines have never been reclassified from C when less harmful drugs have category B or even A classifications. David Blunkett could have ensured that happened when he was minister in charge but he did not.

The Department of Work and Pensions exists it says - ‘to promote opportunity and independence for all, help individuals achieve their potential through employment, and work to end poverty in all its forms.’ There are between 1 million and 1.5 million addicted benzodiazepine victims of medicine and clinical judgement today and there were approximately the same numbers in 2001 and in 2005. Indeed there were similar numbers in 1994 (the relevance of that date will be seen below). Many of the great number addicted by doctors in their pride and ignorance were addicted decades ago and many (particularly but not exclusively) men have been unable to work and follow the normal processes of life. They are therefore poor. As Department of Works and Pensions minister, David Blunkett could have brought the plight of the benzodiazepine victims to the attention of government, but he did not.

He joined the shadow cabinet in 1992 as Shadow Health Secretary and on 24 February 1994 he wrote the following letter to Barry Haslam, a victim of prescribed lorazepam, benzodiazepine campaigner and voluntary counsellor.



H O U S E OF C O M M O N S
LONDON SW1A 0AA

DAVID BLUNKETT MP
Shadow Secretary of State for Health
and Member of Parliament for Sheffield Brightside

24 February 1994

Dear Mr Haslam
Thank you for your recent letter regarding Benzodiazepine Tranquillisers.
Dawn Primarolo and myself have been taking up cases and have advised on how best the groups involved might organise a parliamentary lobby and keep attention on these issues.

We have also tried to assist through both Parliamentary Questions and raising the matter on the floor of the House, in pushing the Government to accept its own responsibilities and to take action now to ensure that it does not happen again.

This is something we will be returning to both in the House and in terms of our own future policy development.

I am passing your letter to Paul Boateng who, as the legal affairs spokesman, has specific responsibility for the litigation side of what is a national scandal.

With all good wishes

David Blunkett MP
Shadow Secretary of State for Health

Former Tory Chancellor Nigel Lawson described the NHS as 'the closest thing the English have to a religion'. Friedrich von Hayek said that if our beliefs prove to be dependent on factual assumptions shown to be incorrect, it would be hardly moral to defend them by refusing to acknowledge the facts.

Blunkett knew the facts and knew what medicine had done in spite of its protestations of innocence. In effect by his inaction, Blunkett immorally maintained the status quo as regards benzodiazepines and allowed the situation to go on unchallenged and unaltered. He allowed the public to continue to view medicine as beneficial and good for both body and soul, when it had carried out with impunity a great scourging of the innocent and trusting.

Jan Moir, writing in the Daily Telegraph on 25 July 2007 said:

“For too long, the default attitude towards British GPs has been that they are long-suffering, hard-working and over-stressed, yet somehow remain a dedicated band of trustworthy professionals in whose hands we are safe. Instead of complaining, we should be grateful to them for any medical attention that we get. Yet you don't have to look very hard to see that there is another diagnosis that also has merit: a second opinion that suggests a malaise at the core of our primary care system, with a number of GPs who are incompetent at best, and uninterested in our welfare at worst...”

Medicine and Politics are the two areas of life that hold responsibility for a solution to the scandal; it is not the responsibility of ordinary people outside those systems – the lumpenproletariat as Marx described them, but they should be aware if only for their own protection. Adam Smith famously remarked that a man is likely to be more concerned by the imminent prospect of losing his own finger than the death of thousands in a Chinese earthquake. That is the way of humanity, there are unfortunately, few who can look outside themselves and feel empathy for the plight of others. As far as NHS activities are concerned, it is often better to not believe it.

A report from the World Health Organisation last month said that a 'toxic combination' of bad policies, economics and politics is killing people on a large scale [in the UK]... ‘Social injustice is killing people on a grand scale.' Government policies to do with benzodiazepine prescribing are contained within that condemnation – long term prescribing often leads to catastrophic ill health and to inescapable poverty. Blunkett could have helped to do something about that but he did not. It is difficult to escape the conclusion that politicians and bureaucrats who directly serve the state believe the interests of the state are supreme and not the welfare of individuals.

Steve Webb the Liberal Democrat health spokesman said in 2006:

"The fundamental priority for the NHS must be patient safety, with a culture of openness and accountability. For it to take years for incidents to be recorded and for good practice to spread is lamentable...The buck must stop at the door of the Department of Health."

It is almost fifty years since the addiction of patients by doctors with benzodiazepines began and the buck has still to reach the door of the Department of Health; medicine has been allowed to believe it did nothing wrong or avoidable. David Blunkett knew better and recognised the scandal when in opposition to government and then conveniently forgot it when Labour came to power in 1997. There may be no-one in government who recognises his responsibility, but campaigners do.

Where once journalists were active gatherers of news, now they have generally become mere passive processors of unchecked, second-hand material, much of it contrived by PR to serve some political or commercial interest. Not journalists, but churnalists. An industry whose primary task is to filter out falsehood has become so vulnerable to manipulation that it is now involved in the mass production of falsehood, distortion and propaganda. Nick Davies, The Guardian, Monday February 4, 2008

"What you see now are journalists who are grateful for news which is almost perfectly packaged to go into the paper with a ready top line. In that sense, journalism is becoming very passive. It is a processor of other people's information rather than being engaged in actively seeking out and determining what the truth of a situation is in an energetic and inquisitive way." Paul Lashmar, investigative reporter and lecturer in journalism, University College Falmouth, 4 August 2008

On 3rd September 2008, a ‘Daily Mail reporter’ and the BBC, treated the reader to the news that 'Mother's little helper' had returned as illegal drug-takers were using more Valium as a cheaper alternative to heroin. Both reporters had obviously read the same handout from DrugScope and thought no further. Both reports had no real context - presumably it would have required effort to provide it, and the Daily Mail in particular decided to reinforce the misleading statement that Valium was over-prescribed to patients in its heyday in the 1960s and 1970s. Anybody reading that would reasonably assume that this was an historical problem. This is far from the truth.

There are no reliable figures for benzodiazepine prescriptions before1978 when there were 30.6 million prescriptions. I say benzodiazepine prescriptions because Valium was not the only ‘mother’s little helper’ being prescribed, it was merely the most well known and formed part of a whole range of almost identical tranquilliser drugs – temazepam, nitrazepam, triazolam, ativan, librium, oxazepam lormetazepam, loprazolam, clonazepam, clobazam, alprazolam, flurazepam, clorazepate, flunitrazepam, bromazepam, ketazolam, medazepam and prazepam were others. From 1979 to 1989 there were a total of 297.7 million prescriptions for benzodiazepines in the UK.

1979 30.9
1980 29.1
1981 29.5
1982 29.7
1983 28.7
1984 28.0
1985 25.7
1986 25.3
1987 25.5
1988 23.2
1989 22.1
Total 297.7 million prescriptions in eleven years

The heyday for tranquillisers clearly extended beyond the 1960s/1970s and in Scotland prescription figures are rising today. Any reduction in prescribing figures is solely due to rising levels of SSRI (e.g. Prozac, Seroxat) and Z drug (e.g. zopiclone, zaleplon) prescriptions. These drugs too have their problems to say the least. Apart from that there was nothing really new in the report – in March 2006, the Observer newspaper had under the headline ‘Cocaine teens fuel big rise in Valium abuse’ also reported that ‘mother’s little helper’ was damaging a fresh generation who were using it to relax and sleep after taking cocaine or amphetamines. It noted an unawareness that:

“the little blue pills are potentially fatal when taken with alcohol, as well as being highly addictive. Patients who try to come off the tablets suffer withdrawal effects for weeks, including hallucinations and anxiety attacks, which can be worse than the symptoms that accompany withdrawal from cocaine or ecstasy.“

Although we can take issue you with the ‘several weeks’ statement which is far from true for large numbers of patients (many people requiring years to complete successful withdrawal), at least the article pointed out that Valium (and therefore its cousins) were seriously hard drugs.

But let’s highlight the plight of patients who thought they were being given medicine and let’s campaign on their plight. It will be a brave new media world when that happens. The 1 million to 1.5 million patients currently addicted to prescription benzodiazepines would appreciate the media pointing out that there is something very wrong with medicine and government avoiding all aspects of this scandal and concentrating all their energies on assistance for and control of illegal users of identical drugs.

Many of those addicted to prescriptions of Valium in its ‘heyday’ are still addicted today and many died. Side-effects number over 200 and many patients never recover. This is an aspect of the story that the media does not seem to want to find the wherewithal to analyse.

"If any drug over time is going to just rob you of your identity and be an ironic reaction
to early effectiveness [leading] to long, long term disaster, it has to be benzodiazepines."
Dr John Marsden, Government Adviser on Drug Addiction, psychologist and senior lecturer in
addictive behaviour at the Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, senior editor of the scientific journal Addiction. Britain's Deadliest Addictions, Channel 4, 1.11 2007

"The benzodiazepines are arguably, the most researched psychoactive drugs in the history of
medicine. There is a most substantial body of research that confirms the effects of these
drugs as broadly deleterious to lucid thought, comprehension, understanding, decision making
and judgemental abilities."
Professor Ian Hindmarch
30th January, 1997

The benzodiazepines have for several decades been recognized in the literature and clinical practice for their capacity to cause mental and behavioural abnormalities. The brain-disabling or toxic effects of the benzodiazepines in general can be divided into several somewhat overlapping categories:

1. The primary clinical effect of inducing sedation (tranquility) or hypnosis (sleep), which is indistinguishable from a toxic effect except in degree;

2. Cognitive dysfunction, ranging from short-term memory impairment and confusion to delirium;
Peter R. Breggin, M.D. Brain-Disabling Effects of Benzodiazepines


The risks of the benzodiazepines are well-documented and comprise psychological and physical
effects. Among the former are subjective sedation, paradoxical release of anxiety and/or hostility, psychomotor impairment, memory disruption, and risks of accidents.
Professor Malcolm Lader, OBE, DSc, PhD, MD, FRC Psych, FMedSci
Professor of Clinical Psychopharmacology,
Institute of Psychiatry, London

When they first came out they were seen as some sort of panacea – or universal remedy. But
with constant use it was found they turned people into zombies in the end."
Dr Ian Telfer, Consultant Psychiatrist


If you’ve got this far, then you’ve read the scientific pronouncements above. You won’t find
any serious scientist disagreeing and you will find a huge population of former patients nodding their heads glumly. What they don’t understand is why the government has allowed and still allows citizens they are supposed to protect to be destroyed. What they don’t understand is why the majority of doctors still don’t know what benzo addiction really means and how it manifests itself in hundreds of ways. What they don’t understand, is why when their health and lives have been swept away by prescriptions, the Department of Health declares them to have done it to themselves. What they don’t understand is why nobody is in any way willing to help or offer recognition.

Some benzo addicts wear their drugs with pride, glorying in the severity of their condition, I know I did. You can call this a personality disorder or you can call it mind manipulation by the primary drug, the benzodiazepine. The truth is that benzodiazepines are mind benders of the first order and producers of cognitive symptoms that would not disgrace a psychiatric ward. Benzo addicts do in fact frequently end up there, and you might see the irony in the fact that state sanctioned prescriptions from doctors can do that to you. I think most people would agree if asked in a poll, but the Department of Health in essence declares this state of affairs to be a perfectly acceptable occurrence – when it says anything at all on the subject that is. There is further irony in the fact that there are people still taking benzos (many having taken them for years) who are firmly convinced they cannot live without their drugs – and that the drugs ward off suicidal thoughts and great anxieties. It is certainly a belief, but since benzos induce depression and anxiety, I don’t believe it’s true, particularly since any beneficial effects of the drugs wear off after a few weeks or months. Did the prescriber tell them about benefits wearing off or more likely did he say that they needed the drugs like some people need insulin and might need them for life - did he even notice they were still taking them?

There are moral and ethical people in this world but the UK government is neither moral nor ethical. Anyone who allows the benzo situation to continue is egregiously immoral and does not have the first understanding of ethical behaviour implied in the notion of democracy.

Bear in mind that the science on benzodiazepine damage and effects is unarguable -

What the UK government will not do

• It will not make any public admission of that damage.
• It will not admit that prescribing has been dangerously inappropriate and out of control
• It will not accept any central responsibility for safeguarding citizens, preferring to point to the responsibilities of doctors, local health authorities and patients
• It will not debate the subject either in writing or face to face
• It will not accept the responsibilities of the benzodiazepine manufacturers
• It will not accept that the drugs regulator has failed and will not beef up its role
• It will not inform doctors of the full meaning of benzodiazepine addiction, including what happens to patients’ lives when they become addicted
• It will not insist that doctors follow a nationally agreed protocol for withdrawal
• It will not enable patients to control inappropriate prescribing by giving them easy access to the law
• It will not commission scientific studies to validate beyond doubt the patient experience
• It will not provide rehabilitation or support
• It will not ensure that patient leaflets give realistic advice and reflect reality
• It will not recognise the impact on the economy and the cost to the NHS of the prescribing of new drugs and tests which are the result of benzodiazepine effects

What the UK government will do

• It will emphasise the importance of the UK drugs industry to the UK economy
• It will continue as part of its avoidance strategy to persecute patients who are on benefits, leaving it to them to prove to the Department of Works and Pensions that they are indeed sick and not work-shy exploiters of the benefits system
• It will take a view as part of its attempt to mitigate responsibility for itself that patients addicted by doctors knew what they were doing when they became addicted and are the same sort of people who become addicted by buying their drugs on the internet or the street
• It will insist that treatment (where it exists) in mental hospitals and drug misuse centres is appropriate for patients addicted by doctors
• It will prevent patients accessing legal redress
• It will ensure that questions asked in parliament are not answered and are evaded
• It will ensure that so-called clinical judgement is preserved

The newspapers are reporting as I write that The NHS drugs rationing body NICE is reviewing its funding limit for new drugs after a series of campaigns by patients groups denied access to treatment. The only way that tens of thousands of benzodiazepine damaged patients (who did have access to treatment they wish they had never had) might see their case heard, is either by mass demonstration or if the government decides in its wisdom that prescriptions are fuelling the illegal market beyond a point they see as acceptable. There have been and will be no demonstrations, simply because current patients have no idea what is happening to them and former patients not only have to live with physical disabilities but minds too degraded to look beyond their limited existence.

The World Health Organisation statement this week that a “toxic combination” of bad policies, economics and politics was killing people on a large scale could have been written for benzodiazepine victims.