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Letter to Dawn Primarolo MP, Health Minister
December 19, 2008
Dawn Primarolo MP
Minister of State
Department of Health
19 December 2008
Dear Ms Primarolo,
I am writing to you on the subject of Professor David Nutt, recently appointed chairman of the ACMD for two reasons –
I know that as far back as the 1980s you were seriously concerned about the impact on patients of these drugs as were David Blunkett and Paul Boeteng, and asked a series of questions in the Commons.
I know that you will therefore be aware that what David Blunkett referred to as a 'national scandal' has still not been resolved.
In 1980 the Committee on the Review of Medicines, in its 'Systematic Review of the Benzodiazepines' concluded that:
"The number dependent on benzodiazepines in the UK from 1960 to 1977 has been estimated at twenty-eight persons. This is equivalent to a dependence rate of 5–10 cases per million patient months."
By that time there had been hundreds of millions of prescriptions and the conclusions, as they were simplistically based on the number of Yellow Cards received were as you know nonsense.
In 1988, based presumably on a more accurate assessment of the facts and available research, the Committee on the Safety of Medicines issued Current Problems 1988; Number 21: 1-2.which said among other things that:
'Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness.'
In January 2004, with an understanding that benzodiazepines were still being over-prescribed and doctors were ignoring the advice in the British National Formulary, the Chief Medical Officer Sir Liam Donaldson wrote in 'A communication to all doctors from the Chief Medical Officer CMO's Update 37.'
"Doctors are being reminded that benzodiazepines should only be prescribed for short-term treatment, in light of continued reports about problems with long-term use. Clear guidance for appropriate use was published in 1988 by the Committee on Safety in Medicines (CSM)."
This advice from government coincides with and reflects accurately the position of a large number of authorities and agencies around the world but now it is clear that a senior government adviser in the Home Office does not agree with this position and is actively seeking to overturn it in this country.
I have read papers from Professor Nutt in the past. Professor Nutt was still saying at the end of the 20th Century:
"The case for benzodiazepine dependence causing real damage has not been made."
Recently I was made aware of a lecture he gave in Newcastle in November 2008. Presumably he will continue to make others in an attempt to disseminate his view of things as widely as possible. The lecture to around 100 psychiatrists, researchers, academics and medical students cited no plausible evidence for his position but nevertheless his expert opinion regarding benzodiazepines was
That tolerance does not develop to the anxiolytic effects of benzos.
It is possible to take them for as long as you like (many years) and problems will only occur in withdrawal. He did not mention the effects of benzodiazepines on thinking processes, on human aspirations, relationships, economic activities and the many reported physical effects.
The crucial point about these views, which former patients who have experienced the injuries produced by benzodiazepine use find disgraceful, is that Professor Nutt is a very influential man with ready access to doctors in the NHS. As well as being the chairman of the ACMD, he is Professor of Psychopharmacology at Bristol, a Clinical Consultant in pharmacology and Editor of the Journal of Psychopharmacology. It is clearly not possible for the DoH to maintain that it is doing all it can to reduce the incidence of addiction when Professor Nutt, as a key government figure is on the ground, doing all he can to increase it.
According to the Medical Research Council website for 2008 he has the following major declarations of interest:
Personal Remuneration (employment, pensions, consultancies, directorships, honoraria etc) Consultancies/Advisory Boards – Pfizer, GSK, Novartis, Organon, Cypress, Lilly, Janssen, Lundbeck, BMA, Astra-Zeneca, Servier, Hythiam, Sepracor Speaking Honoraria – Wyeth, Reckitt-Benkiser, Cephalon Grants or clinical trial payments – MSD, GSK, Novartis, Servier, Janssen, Lundbeck, Pfizer, Wyeth, Organon
Professor Nutt is clearly seen by Pharmaceutical companies as an Opinion Leader and gave his lecture not only to present prescribers but to future prescribers as well. I am sure you will see the grave contradiction in all of this and the likely serious consequences for the health of NHS patients. Patients reporting to the Department of Health what has happened to them through tranquilliser prescribing are told that the department's priority is to prevent addiction occurring in the first place. They are told of the CSM Guidelines on prescribing, the CMO's reminder and the advice in the BNF. On the other hand we have a senior government adviser with a significant position now actively declaring that there is not much wrong with the drugs and they can be safely prescribed indefinitely.
I have no doubt you will agree that in disseminating such views, Professor Nutt cannot be seen as merely expressing an opinion, on a similar basis to individual doctors exercising clinical judgement. Professor Nutt holds an official government position and therefore his assertions will carry great weight with doctors. Patients and yourself in the 1980s and 90s, fought hard to ensure recognition of tranquilliser drugs as addictive and broadly deleterious to health. Indeed last year, reinforcing this truth, Dr John Marsden, himself a member of the ACMD said:
"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."
If the DoH is to allow the views of David Nutt to be broadcast as though there is a possibility that they might become official pronouncements, or if it sees them as merely part of a debate, where does that leave all that has been said in the past by the department? The current CMO, all advisers past and present and researchers around the world would look foolish to say the least if Professor Nutt's views are allowed to gain wider acceptance in medical practice. Where does that leave the legal position of patients? It is extremely difficult to gain legal redress for injury due to the over-prescribing of tranquillisers, not least because of the Bolam principle, but if that defence is strengthened because individual doctors can point to expert opinion they received in a lecture or through an article written by Professor Nutt, then it will become even more so.
Professor Nutt is reported to have said that he seeks to change DoH guidance. In doing so he is attempting to speak and write out of existence the very real experience of large numbers of people and one wonders why he is doing it. Is he misguided, blinded by the pursuit of academic medicine or his relationship with drug manufacturers? Whatever the reason, he is wrong in his conclusions. But the consequences of the influence of his views should not be under-estimated or dismissed.
I would very much appreciate your comments in due course.
December 19, 2008
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