Colin's Blog

Thalidomide drug scandal victory in sight

http://www.timesonline.co.uk/tol/life_and_style/health/article6917277.ece

THE government is proposing a multi-million-pound settlement for the surviving victims of thalidomide in an attempt to lay to rest the long-running drug scandal.

Ministers have tabled a deal which would provide each of the 460 remaining thalidomiders with an average of £18,000 a year. The British state would also issue a public apology for its role in the tragedy.

Campaigners for the victims have been negotiating with Mike O’Brien, the health minister, and are due to meet him again this week. A settlement could be announced before Christmas.

The development comes after a Sunday Times-backed campaign for ex gratia payments to be made to the thalidomiders in recognition of the state’s role in allowing the drug to be prescribed on the National Health Service during the 1950s and 1960s.

The victims, who were born with deformed arms and legs or with brain damage after their mothers took the thalidomide anti-morning sickness pills, are now facing spiralling medical and living costs as their bodies start to fail because of the unnatural stresses placed on them. They are having to pay out of their own pockets for wheelchairs and specially adapted cars which cost up to £60,000.

Last week The Sunday Times told how Veronica Pakenham, restricted to a wheelchair because all her limbs have been damaged by thalidomide and who has also suffered a stroke, had been told by a local health trust that she was not entitled to 24-hour care. The ruling was reversed within days of the article being published.

All the UK survivors receive yearly disbursements from the Thalidomide Trust, which is funded by a settlement with Distillers Biochemicals, the company that distributed the drug in Britain.

Until now the government has failed to make a positive contribution, even though a state agency approved the drug for use by the NHS in 1958. When the campaign was launched earlier this year Alan Johnson, the then health secretary, said he was “not persuaded” of the legitimacy of the cause.

Since then 270 cross-party MPs have signed an early-day motion calling for the payments and a series of articles in this newspaper have highlighted the thalidomiders’ plight. Sources close to O’Brien say he accepts the basic legitimacy of the campaigners’ case and its financial implications.
 
His proposal involves paying about £8m a year to the Thalidomide Trust using personal health budgets boosted by money from central government. Nick Dobrik, leader of the thalidomider campaign, said: “We are hoping that a deal can be agreed in a very short time.”

Dr Martin Johnson, director of the trust who was at the meeting last week, said: “Mike O’Brien made it plain that he was keen to come up with an arrangement focused on helping our beneficiaries.”

The Department of Health said: “Everyone has the greatest sympathy for patients and families affected by thalidomide. Representatives of the trust are meeting Mike O’Brien next week to further discuss their concerns.”

- Benzo Drug Scandal Continues

Received November 12 2009

Our ref: DE00000456977
 
Dear Mr Downes-Grainger,
 
Thank you for your email of 4 November to Baroness Thornton about tranquilisers.  I have been asked to reply.
 
As she made clear in her response to Lord Montagu’s question in the Lords, this is an issue which the Government takes very seriously.  You will be aware that there is a Department of Health review underway into dependence on prescribed and over-the-counter medicine.  The review team is surveying services to support people who become dependent on these medicines reviewing evidence and auditing prescribing data.
 
Your note has been passed to the review team and will be taken into account.
 
Yours sincerely,
 
Edward Corbett
Customer Service Centre 

Email to Baroness Thornton, House of Lords

4 November 2009

Dear Lady Thornton,

May I say that the questions asked by Lord Montagu regarding tranquillisers on 14 October and 3 November 2009, are as relevant today as they were when asked by others over the last two decades or more (including by Dawn Primarolo when she was in Opposition).

It is sad to say that the Department of Health has failed to act in any truly effective way since 1988 when the Committee on the Safety of Medicines, rejecting the very influential Professor John Mark’s view that that the dependence potential of benzodiazepines was so low as to be negligible, sent Guidelines to all doctors. At that time firm figures on the number of patients who had been taking tranquillisers for longer than the CSM Guidelines could have been obtained by analysing doctor records, but it was a chance missed for whatever reason. No such figures have been collected since and it has been left to researchers such As Professor C.H Ashton to obtain reliable estimates of around 180 persons per GP practice – never accepted by the DoH even though it produced no figures of its own

Because clear figures on the number of patients affected by tranquillisers have never been obtained, uncounted numbers of patients have had their health increasingly impacted by continuing prescriptions and indeed their lives generally have been harmed, since the impact of tranquillisers is not merely a medical issue but also a socio/economic one.

You will forgive me, but referring to available levers does not sound too optimistic – Rosie Winterton used that phrase to Heather Ashton and MPs in 2003 as a justification for not doing anything beyond a short note from the CMO to doctors in 2004, a note which achieved little and prompted some doctors to abruptly withdraw medication from patients. Guidance has not protected patients and may well not in the future. Benzodiazepine prescribing has to be controlled in some way – it is controlled when obtained on the street but not when prescribed in the surgery. Many of the estimated one million patients dependent/addicted to benzodiazepines today have been taking benzodiazepines every day (often in large quantities) for years and decades. How that can be seen as safe is beyond most reasonable people. It should be mentioned too that addicted patients are not merely taking one class of drugs which is harming them but as a consequence of the action of benzodiazepines often take a variety of others including codeine – in other words one addiction with side-effects leading to further drugs with side-effects.

The stated intent to commission research into the long-term physical effects of benzodiazepines is of course welcome – no-one has ever done this and as a result the claims of patients have been rejected by doctors and government because there was no evidence, the NERO defence (no evidence of risk is proof of the absence of risk). In the 1980s Professor Ashton made several requests for funding to investigate long-term side-effects but funding was not granted.

Professor Malcolm Lader’s accurate comments have charted a chunk of the history of benzodiazepine prescribing. Psychophamacologist Malcolm Lader was a member of the Committee on the Review of Medicines from 1978–1989:

1978: He described benzodiazepines as the opium of the masses.
1981:  He said there was an epidemic in the making.

Prescribing doctors, as he observed, had enthusiastically taken up the ‘use for everything’ message coming from the manufacturers and the result was a huge edifice of state-countenanced addiction.

1988: He said benzodiazepine addiction was the biggest medically-induced problem of the late 20th Century.

Lader was emphasising the crucial role played by medicine and its prescribers in creating not only an addiction problem which should never have existed, but also one instance of its terrible potential impact on physical health.

1991: He said no real attempt was being made to help addicts come off. Government should set aside funds.

Government has not set aside funds and today replies from the Department of Health imply that addicted patients are drug abusers like those who use benzodiazepines on the street and/or they are obtaining their drugs from the internet. The latter is a growing problem but is not the main cause of the problem which was caused by medicine in the vast majority of cases. Today too, Professor David Nutt seems bent on rolling back the CSM Guidelines. For years now he has been pushing the message through lectures that benzodiazepines are not as black as they are painted.

In a recent Newcastle lecture to medical students and other medics he said that tolerance does not develop to the anxiolytic effects of benzodiazepines. Therefore, because they maintain their effectiveness for this action, benzos can be used long term to treat anxiety states. He said that problems only arise if/when the benzos are stopped. He fully acknowledged a withdrawal syndrome, but failed to mention that adverse effects (e.g. increasing anxiety due to tolerance) do actually arise during long term treatment, as well as impaired cognition and memory, traffic accidents, falls and fractures in the elderly, etc. Small wonder then, that patients and their representatives, after 50 years of over-prescribing and decades of evidence that David Nutt now seeks to set aside, do not feel optimistic.

The first two quotes summarise David Nutt’s position – the ones below are far more accurate.

"The (benzodiazepine) withdrawal period lasts between sort of 4 days to a couple of weeks at most I think." Prof. David Nutt, Brain Mechanisms and Treatments of Anxiety Disorders, Lundbeck Institute, November 2005.

“The case for benzodiazepine dependence causing real damage has not been made.” Prof. David Nutt, former chairman of the ACMD.

"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, Member of the ACMD, Britain's Deadliest Addictions, Channel 4, November 1, 2007

"Withdrawal symptoms can last months or years in 15% of long-term users. In some people, chronic use has resulted in long-term, possibly permanent disability." – Professor C Heather Ashton DM, FRCP, Good Housekeeping, August 2003.

"Some people have been on benzodiazepines for many years, and it is very difficult to get them off because they are very addictive." – Dr Peter Fellows, Chairman of the British Medical Association's prescribing committee, BBC News February 11, 2004.

"It is difficult to defend that we have such a huge problem of benzodiazepine prescription and long-term use and therefore dependence. – Professor Louis Appleby, National Director for Mental Health, The Tranquilliser Trap, BBC Panorama, May 13, 2001.

"It is more difficult to withdraw people from benzodiazepines than it is from heroin. It just seems that the dependency is so ingrained and the withdrawal symptoms you get are so intolerable that people have a great deal of problem coming off. The other aspect is that with heroin, usually the withdrawal is over within a week or so. With benzodiazepines, a proportion of patients go on to long term withdrawal and they have very unpleasant symptoms for month after month, and I get letters from people saying you can go on for two years or more. Some of the tranquilliser groups can document people who still have symptoms ten years after stopping." – Professor Malcolm H Lader, Royal Maudesley Hospital, BBC Radio 4, Face The Facts, March 16, 1999.

"Release and self-help groups all over the country have done wonderful work, but why should people need to form groups for an urgent medical problem? This is drug-induced disease, not drug abuse." Tyrer P. The Benzodiazepine Post-Withdrawal Syndrome. Stress Medicine 1991; 7: 1-2.

"I have started a support through withdrawal scheme for people coming off benzodiazepines. The enormous amount of suffering I see makes me wonder how much information on the toxic effects of these drugs, and illness caused by their withdrawal, reaches the doctors. The pharmacological manuals grossly understate the dangers of tolerance, dependence and withdrawal that have been demonstrated so clearly after the use of these drugs. This is not only after long-term use at high dosage, but also after very short-term use (two weeks), on a normal therapeutic dose.....

Thousands of people could not possibly invent the bizarre symptoms caused by the therapeutic use of benzodiazepines and reactions to their withdrawal. Many users have to cope, not onlywith a frightening range of symptoms, but also with the disbelief and hostility of their doctors and families. It is not uncommon for patients to be "struck off" if they continue to complain about withdrawal symptoms. Even when doctors are concerned and understanding about the problem,they often have little knowledge of withdrawal procedure, and even less about treatment. The drugs newsletter on benzodiazepines issued in this region will help them. Is anything being done elsewhere? Trickett S. Withdrawal from Benzodiazepines. Journal of the Royal College of General Practitioners 1983; 33: 608.

Medical research on Benzodiazepine Injury

Yours sincerely

Colin Downes-Grainger

15 Oct 2009 : Column WA30

Health: Drugs

Questions

Asked by The Earl of Sandwich

To ask Her Majesty's Government what is their estimate of the numbers suffering each year (a) from addiction to benzodiazepines and other prescribed drugs, and (b) from withdrawal from such drugs. [HL5567]

To ask Her Majesty's Government whether they will promote greater awareness within the medical profession of the risks of dependence on prescribed drugs. [HL5570]

To ask Her Majesty's Government whether the National Health Service intend to assist local or regional support groups for those who depend on, or are withdrawing from, prescribed drugs. [HL5571]

Baroness Thornton: Addiction to prescription or over-the-counter (OTC) medicines can be a serious problem and the department is undertaking a review looking at:

what information is already available;identifying key gaps in data, such as the number of people who are dependent on, or suffering from withdrawal from, benzodiazepines and other prescribed drugs;services, with a view to highlight and disseminate good practice; and what additional work needs to be put in hand, including services to support people who are dependent on these medicines.

Additionally, the department is currently planning to commission research on the prevalence of, and the long-term effects of, dependence to benzodiazepines and is considering the role of preventive measures and raising awareness among patients and GPs of the risk of dependence that some prescription or OTC medicines have. We expect that this review will be completed next year

The Medicines and Healthcare products Regulatory Agency continuously monitors the safety of all medicines in the United Kingdom including concerns about misuse and dependence, and where necessary, takes suitable action to safeguard public health, this includes revised licences for use and patient information sheets

Health: Side Effects of Medication

House of Lords Tuesday 3 November 2009

2.41 pm

Question

Asked By The Earl of Sandwich
To ask Her Majesty’s Government how they will ensure that doctors and pharmaceutical companies fully recognise the long-term side effects of prescribed tranquillisers and antidepressants, and the nature of withdrawal symptoms.

Baroness Thornton: My Lords, the Government are aware of concerns around prescribing these medicines, particularly after the report of the All-Party Parliamentary Group on Drugs Misuse. The Department of Health is undertaking a review of addiction to medicines which is due to report next year, and of course the Medicines and Healthcare Products Regulatory Agency continuously monitors the safety of medicines on the UK market and issues advice to raise awareness of the potential for side effects.

The Earl of Sandwich: My Lords, I thank the Minister for her reply and I welcome the review. Can she confirm that there are approximately 1.5 million people in the UK who are addicted to prescribed drugs such as benzodiazepines? I declare an interest. A member of my family is confined to his room; he is trying to withdraw from one of these drugs. He cannot work or take the children to school. There is no government benefit or assistance for people in his situation. Can the Government confirm that they are getting on with a proper NHS network of support for these patients?
 
Baroness Thornton: The noble Earl is, I fear, not alone in direct experience of what can happen to people who suffer from withdrawal reactions to these drugs. There are support services available in some areas of the country which have a good success rate in helping people to withdraw from medicines to which they have become inadvertently addicted, but we recognise that the availability of these services is variable and patchy. Our review will seek to identify what needs to be done to better support people experiencing these problems. We will also review the services that are currently provided in order to gauge the level of support available, and draw on best practice to ensure that we get full cover and support for people in these situations.

Lord Ashley of Stoke: My Lords, have the Government made their own special study of the effects of these tranquillisers? Are they able to impose their views on doctors and pharmaceutical companies? Does the Minister agree that pharmaceutical companies can be far more resistant to pressure from the Government than doctors and that it will require much stronger pressure on the companies than on the medical professions?

Baroness Thornton: My noble friend asks a very pertinent question. Product warnings are kept under close review. One example of this relates to products containing codeine, where new, hard-hitting warnings such as “can cause addiction” and “for three-day use only” on the front of the pack will be introduced next year. Guidance to the healthcare professions will be considered as part of the review that is taking place.

Lord Williamson of Horton: My Lords, I declare an interest as a patron of Rethink, the mental health charity, which does excellent work. There is also the medication helpline of the Maudsley Hospital. Will the Minister consider whether there could be improvements in the information available to those who suffer from mental health problems as the result of withdrawal from prescription drugs? There may be a gap there that we could help to fill.
Baroness Thornton: The noble Lord makes an important point, and the review will be looking at that. There are examples in Liverpool and Bristol of counselling information, education and advice being made available to people, but the noble Lord points to the importance of telling people who are being prescribed these drugs what the side effects might be.

Lord Elton: My Lords, will the inquiry bear in mind the advisability of advising doctors not merely on the dangers of addiction but on the method of keeping in view the condition of people for whom they prescribe these drugs long-term, and who will become addicted without their own knowledge unless they are carefully monitored?

Baroness Thornton: There is a great deal of information available to prescribers of these drugs: the British National Formulary; product information; the National Prescribing Centre, which has an excellent record; and—for the treatment of depression, for example—NICE guidance talks not only about the effect of prescribing but about the need to provide other therapies to people who are suffering from depression.

Baroness Barker: Does the Minister agree that it would be beneficial if all pharmaceutical companies were required to print information about the half-life of tranquillisers and anti-depressant drugs, so that individuals trying to manage the process of coming off them could do so knowing what the effects were likely to be over a short period?

Baroness Thornton: In answer to a Question put by my honourable friend Jim Dobbin, the Minister said that:
 
“The half-life of a drug intended for use as a sleeping tablet is only one of many factors that influences the safe use of a medicine. Information to aid … safe use … is provided in the product information which consists of the Summary of Product Characteristics … and the Patient Information Leaflet”.—[Official Report, Commons, 20/5/09; col. 1435W.]
The key point is that those resources are used at the right time.

Lord Crisp: My Lords, in setting up the review, will the Minister ensure that it takes full account of implementation? She will know as well as I do that there is a difference between policy and implementation. Does she have any thoughts about how to ensure that this policy, which needs to be a very personal one to every member of the primary care team, is disseminated so that people are not only aware of it but follow it in practice in all the individual cases that we are talking about?
 
Baroness Thornton: The review will be completed next year, with a report published later in the spring. We are doing a counting exercise, reviewing evidence of the prevalence of addiction, effective treatment and the long-term effects of the use of a range of antidepressants, sleeping pills and codeine-based painkillers. That will influence future policy. The noble Lord is right, though, that the policy leadership within the department has to address how to ensure that this is rolled out and how to use the machinery and levers that we have to ensure that it is implemented.

Baroness Gardner of Parkes: My Lords, does the Minister agree that these drugs are obviously very complicated and must be of benefit to a number of patients or they would not be in such common use? Does she have any figures on the percentage of people who become addicted?

Baroness Thornton: I do not have any figures on the percentage of people who become addicted. That is part of the exercise that we are undergoing. The noble Baroness is right that we must not forget the impact of depression, for example, on sufferers, and that depressive illness is a debilitating condition. One in four women and one in 10 men in the UK is likely to suffer from depression at some point in their lives, and these drugs will help to transform their lives and enable them to cope and recover.

Lord Acton: My Lords, does my noble friend agree that “next year” is a rather long and elastic time? Could the review not be tightened up a bit?

Baroness Thornton: We are moving with all speed because we know that this is important, but I promise my noble friend that I will take his views back to the department and see if there is any way that we can hurry up.


 

Yes, scientists do much good. But a country run by these arrogant gods of certainty would truly be hell on earth

By A N Wilson 3rd November 2009

http://www.dailymail.co.uk/debate/article-1224858/Yes-scientists-good-But-country-run-arrogant-gods-certainty-truly-hell-earth.html

The row between the Government and its scientific advisers blazes on like an out-of-control forest fire.

It began with that difficult customer Professor David Nutt, who was chairman of the Advisory Council on the Misuse of Drugs. He told the Home Office that alcohol and tobacco were more dangerous than the banned substance cannabis, and horse-riding was more of a risk to your health than ecstasy.

But he was not content simply to give advice, of course. What he appeared to want to do was to dictate to the Government, and when it refused to acknowledge his infallibility, Professor Nutt started to break ranks and to denounce the country's law on drugs. Now he has been sacked, the scientific establishment is in an uproar of self-pity and self-importance. How dare mere politicians question their judgments? They are scientists, aren't they? And what scientists say must be taken as true.

The trouble with a 'scientific' argument, of course, is that it is not made in the real world, but in a laboratory by an unimaginative academic relying solely on empirical facts. It is one thing to argue Professor Nutt's case in a university common room or over a Hampstead dining table, but another to translate his arguments to murkier parts of our society.

Try saying that ecstasy is safe in the sink estates of our big cities, where police, social workers and teachers work to improve the lives of young people at the bottom of the heap. Try saying it to those who see, every single day, the devastation wrought not only on the youngsters themselves, but on whole communities by the casual abuse of drugs

Bluster

If you add together all the winos and self-destructive alcoholics, then throw in the smokers who've died of respiratory or cardiac disease, the total will far outstrip the number of young people who die after taking an ecstasy pill - and you could conclude from this that smoking and drinking are more dangerous than ecstasy. That does not mean it is safe to take ecstasy nor that it is desirable to tolerate a druggy culture among the impressionable young.

This whole debate between David Nutt and the Government is about much more than the simple academic question over the relative dangers of cigarettes, drink and other drugs. What is on trial is the reputation of science.

Of course, it would be folly to deny that we all owe a vast debt to scientific discoveries, made by patient, intellectually rigorous men and women over the past few centuries. Just think what we owe to developments in medicine, let alone all those technologies we now depend upon, from cars to computers.

Nor would I ever wish to suppress scientific inquiry or to undervalue the good which scientists have done for our world. But there is an increasing presumption among many intelligent and good-hearted people that science is an absolute truth, that its methods of arriving at the truth are infallible and that scientists must be listened to at all times. A Home Secretary who sacks a plucky little scientist for daring to speak his mind - correction, daring to speak 'the truth' - is surely worthy of our contempt? That is how the scientific establishment has portrayed the story as they line up to denounce Alan Johnson. Before we get carried away by their bluster, we should recognise the arrogance for what it is. What the scientists are saying basically is that they will brook no contradiction. Yet if we examine the history of scientific experts - and, in particular, scientists advising governments - they do not have a very happy record.

Do you remember the foot-and-mouth outbreak of 2001? All reasonable farmers and vets believed that the epidemic could be contained by vaccine, or simply by isolating animals. But the Chief Scientific Adviser to the Government, David King, insisted upon a massive cull.
 
Millions of sheep and cows were destroyed, and every hill and valley, which once echoed to bleating or lowing was silenced and despoiled. Did we ever hear a word of apology when events proved this government scientific adviser wrong?
 
We hear a lot about the bovine brain disease BSE which was passed onto humans, and the possible cures which science might effect. But how often do we hear that BSE was almost certainly passed on to other cattle because scientists had encouraged farmers to force their animals to eat concentrated foods which contained beef products?

Going back in time, some people think that Hitler invented the revolting experiments performed by Dr Mengele on human beings and animals.

Irrationality

But the Nazis did not invent these things. The only difference between Hitler and previous governments was that he believed, with babyish credulity, in science as the only truth. He allowed scientists freedoms which a civilised government would have checked.

I am not suggesting that any British scientists are currently conducting experiments comparable to those which were allowed in Nazi Germany or in Soviet Russia. But I see the same habit of mind at work in Professor Nutt and his colleagues as made those mad scientists of the 20th century think they were above the moral law which governs the rest of us mortals.
 
The worship of science is the great superstition of our age. The scientific adviser speaks and we are all supposed to believe him, whether he is promoting crops genetically modified to withstand huge doses of poisonous weedkillers and pesticides, or tampering with the origin of human life itself in so-called stem cell research.
 
Those who dare question scientists are demonised for their irrationality. Global warming may or may not be a certainty, but anyone who queries it has his sanity questioned. Cast doubt on these gods of certainty and you are accused of wanting to suppress free expression - which is the argument now being used by Nutt and pals against the Home Secretary.

In fact, it is the arrogant scientific establishment which questions free expression. Think of the hoo-ha which occurred when one hospital doctor dared to question the wisdom of using the MMR vaccine.

The point here is not whether he was right or wrong - it was the way in which the scientific establishment closed ranks in order to assassinate him. There was a blanket denunciation of his heresy, just as there is if anyone dares to point out some of the mistakes made by that very fallible genius Charles Darwin.

Science rules - and it does so with just as much energy as the old Spanish Inquisition that refused to allow any creed other than Catholicism, and with the Inquisition's need to distort arguments and control the brains of men and women who might otherwise think for themselves.
 
Naivety

In complex areas - medicine, agriculture, astronomy - the politicians who make our laws inevitably have to consult 'experts'. But this is not to guarantee that such experts are always right. As Margaret Thatcher once said: 'Advisers advise and ministers decide.' To be governed by politicians is a necessary evil. To be governed by arrogant scientists would truly be hell on earth.

Listen to the way these scientists are describing one another as they huff and puff at the Home Secretary's treatment of Professor Nutt. 'It will be hard to find a replacement of comparable expertise and stature,' says one pompous ass in the letters column of a newspaper.

Stature? Nutt? Like so many scientific experts, his arrogance is matched by his naivety. Like them, he cannot bear to be contradicted.

And to every one who thinks otherwise, I would ask them to carry out a simple experiment. Put a drug, bought casually on the street corner, and a glass of red wine on the table when your teenager comes home from school. Which of them, in all honesty, would you prefer him to try?

Scientists advise, politicians decide
November 2nd, 2009
Benedict Brogan, The Telegraph

Way back when, nearly 350 economists signed a letter to the Times predicting the end of the world if Margaret Thatcher pressed ahead with her economic reforms. She ignored them, and the rest was national recovery. These days anyone who dares to question the scientific basis for man-made global warming gets it in the neck from the scientific community. And today a chap called Ian Stolerman, who rejoices in the title Emeritus Professor of Behavioural Pharmacology at King’s College London, gives warning that anyone mad enough to take over from Professor David Nutt as the Government’s drugs adviser could be branded a “collaborator”. Nice. Shall we shave their heads and parade them in the streets?  So much for the open-mindedness of scientific inquiry and respect for the views of others.

Alan Johnson takes a healthily robust view of such things, as he shows in his letter to the Guardian in which he points out that Prof Nutt was sacked not for having different views but for campaigning against government policy. And the more I listen to the self-righteous warblings of Prof Nutt’s mates, the more I’m sympathetic to the Home Secretary. If the good professor had checked when he signed up, there was nothing in the small print to say that his advice would be taken. In fact, as my colleague Phil Johnston elegantly sets out today, everything about this Government’s approach to drugs has been supremely unscientific, not least Gordon Brown’s crass politicisation of the issue.

By all means condemn Labour’s drugs policy. But do not mistake that debate for the one about how Governments work. Ministers are entitled, even obliged to seek advice. They are also entitled to get that advice in private. They are also required to make decisions for themselves based not just on advice but on their beliefs and their political instincts. That is what we elect them for. Scientists should keep out of it, and certainly should not take it on themselves to act as a Greek chorus if their advice is ignored. If the politicians get it wrong, the voters will be the ones to judge.

Jeremy Laurance: Scientists can be as irrational about drugs as the rest of us
Medical Life
Tuesday, 3 November 2009

http://www.independent.co.uk/life-style/health-and-families/features/jeremy-laurance-scientists-can-be-as-irrational-about-drugs-as-the-rest-of-us-1813574.html

The war of Nutt's mouth is warming up nicely. The Professor of Psychopharmacology from Bristol University – who until Friday was the Government's chief adviser on drugs – insisted on opening it, while Home Secretary Alan Johnson was determined to shut it.

The spat has now gone nuclear, with everyone from Lord Winston, the Labour peer, to Sir Liam Donaldson, chief medical officer, weighing in. Battle lines have been drawn between rational scientists on one side – independent, objective, evidence-driven– and irrational politicians on the other – craven, vote-chasing, 'Daily Mail'-driven. Is this a fair distinction? Er, no. Scientists are human, too. They struggle to be rational and objective, and they summon evidence to justify their positions, but they are still subject to the same whims, obsessions and prejudices as the rest of us.

Professor (David) Nutt likes to compare the risks of ecstasy (30 deaths a year) with those of horse-riding (100 deaths a year), an activity he is doubtless familiar with in the leafy environs of Bristol, where he and his four children live.
 
Alan Johnson responds that there isn't much horse-riding in his Hull constituency – but there are thousands of young people popping pills on a Saturday night at risk.
 
We are all swayed by our experience. Professor Nutt ranks the risks of cannabis as low, below those of alcohol and cigarettes. Professor Robin Murray, of the Institute of Psychiatry, who has spent his professional life studying people with schizophrenia, amongst whom cannabis smoking is epidemic, thinks they are high enough to warrant concern.
 
Their scientific disagreement calls to mind the scene in Woody Allen's 1977 film 'Annie Hall', in which each of the main characters answers a question from their therapist about how often they have sex. "Hardly ever," replies Alvy Singer, the neurotic New Yorker; "All the time," says Annie Hall, his lover. But both agree it is three times a week.

Experience shapes our view of statistics. Doctors talk about the "last case" phenomenon. If your GP has just had a patient erupt in boils on medicine A, be prepared to accept a prescription for medicine B, even though A may the standard therapy for your condition.

The dominance of experience over evidence was demonstrated in last week's row over caesareans. Latest figures showed Britain's caesarean rate, at one in four of all births, is way above the 15 per cent rate the World Health Organisation has said should not be exceeded. So how did the professional bodies react? With diametrically opposite responses. The Royal College of Midwives, whose members deliver low-risk women, said the figures showed Britain's caesarean rate was too high. The Royal College of Obstetricians, which delivers specialist care to high-risk women, said Britain's rate was in line with other European countries and the status quo was fine. Facts are sacred – but everyone views them from their own perspective.

 

                                   The Canonisation of Professor David Nutt

"The (benzodiazepine) withdrawal period lasts between sort of 4 days to a couple of weeks at most I think." Prof. David Nutt, Brain Mechanisms and Treatments of Anxiety Disorders, Lundbeck Institute, November 2005.

“The case for benzodiazepine dependence causing real damage has not been made.” Prof. David Nutt, former chairman of the ACMD.

"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, Member of the ACMD, Britain's Deadliest Addictions, Channel 4, November 1, 2007

 “Since January a member of my family has been suffering from acute withdrawal from this prescribed drug [a benzodiazepine]: his dreadful symptoms mean he is confined to his room, unable to work and attend to his family. He receives no government or medical support because there is none.”  “The government should take urgent action to help victims of benzodiazepine withdrawal and develop a network of clinics to care for them.” “I would like to see direct support for people who are victims like the member of my family.”’ Lord Montagu, the Earl of Sandwich, The Independent 31 October 2009

An unholy storm has arisen over the last few days over the sacking of Professor David Nutt as head of the Home Office drugs advisory body the ACMD, resulting from his confrontation with government over the relative harm inflicted by cannabis and alcohol/smoking. With the exception of an article by Melanie Phillips in the Daily Mail today, the entire print media and almost all comments to it are supportive of Nutt.

I have no expertise in the relative harm caused by ecstasy, cannabis or LSD but I do have expertise on the damage caused by tranquillisers – I have lived it, am still living it and I have researched it for more than half a decade. Therefore I am aware that the media and those commenting on the media reporting are missing much reality.  If Nutt really were the expert to top all experts, they would have a point about political concerns ignoring hard science. But I am well aware that this ‘expert’ against decades of contrary evidence from a very wide spectrum of academic researchers including Professor Peter Tyrer, Professor Heather Ashton, Professor Andrew Herxheimer and Professor Malcolm Lader, now pushes the message in the medical community that long term use of tranquillisers is not really harmful and real damage is unproven. This view is not only contrary to overwhelming and established research which has led to common Guidelines from drug safety regulators around the world on the use of tranquillisers but also to the experience of uncounted thousands of patients who regard his views as anathema: Medical research on Benzodiazepine Injury

He ignores the damage caused by SSRIs, he thinks we should all be vaccinated at birth against future addiction and we should be free to take cognition enhancers. In short, while making the occasional reference to the dangers of drugs, he seems inordinately keen to maintain and expand their use.

The DoH did not seem to be disturbed by his views on tranquillisers (see correspondence below) and I got the same reply from them when I expressed my concerns about his pushing that message as the Home Office gave when this latest furore over cannabis began i.e. private capacity, personal views etc:

Dawn Primarolo MP
Minister of State
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS

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.

Yours sincerely,
Colin Downes-Grainger
December 19, 2008

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Our ref; 7000000378848                                         
Richmond House
79 Whitehall
London SW1A 2NS


23 January 2009


Dear Mr Downes-Grainger,

Thank you for your letter of 19 December to Dawn Primarolo about Professor David Nutt, the newly appointed Chairman of the Advisory Council on the Misuse of Drugs (ACMD). As you will appreciate, Ms Primarolo receives a large amount of correspondence and is unable to respond to every letter personally. I have been asked to reply on her behalf.

The Department of Health regards involuntary addiction as a very important issue. As you may be aware, the main focus of the Department'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 to benzodiazepines.

I can assure you that the safety of the use of benzodiazepines in routine clinical practice is closely monitored by the Medicines and Healthcare products Regulatory Agency (MHRA). Any possible new safety issue to emerge is evaluated and, if necessary, appropriate action will be taken and the product information for prescribers and patients updated.

As you are aware, concerns about the safety of benzodiazepines, especially in relation to the risk of involuntary addiction, has led to action being taken by the Department, the MHRA and other professional bodies to limit prescribing, provide extensive warnings about the risks of dependence and advice about gradual withdrawal. Health professionals were informed of these changes and various reminders have been distributed by the MHRA and the Department of Health since 1980.

The Department is aware of recent comments made by Professor Nutt. However, the Department understands that said comments were made in a professional capacity and not as part of his role of Chairman of the ACMD,    I would like to clarify that Professor Nutt's views on benzodiazepine do not reflect the ACMD's views on this matter as a whole.

I hope this reply is helpful.
Yours sincerely,
 
Dora East
Customer Service Centre Department of Health


This is not simply an argument about whether scientific proof is being ignored by politicians for political purposes it is also about a man not being the expert he is declared to be on one class of drugs. Does that extend into others? And I wonder if he would have received the same reaction from government had he stood up and declared publicly his views on tranquillisers? 

Benzodiazepines are hard drugs though the risks of physical dependence are minimised; their prescription is regulated by poorly trained doctors who are incapable of managing coherent withdrawal programmes and all this in the interest of whom...of what? It is a major public health problem on a planetary scale which unfolds in the most total silence!

Frenchwoman Isabelle Barrat
Benzodiazepine Online Petition 

Action on Britain's epidemic of pill addiction
Peer to use House of Lords speech to reveal relative's addiction to prescription drug

By Jeremy Laurance, Health editor, the Independent

Saturday, 31 October 2009

As early as 30 years ago, the addictive properties of tranquillisers such as Valium were known, but critics maintain the Government is still not doing enough to help.
 
The Department of Health has launched a review of the million-plus patients addicted to prescribed drugs in the UK in a tacit admission that attempts to control the problem over the last two decades have failed.
 
An estimated 1.5 million people are addicted to prescription and over-the-counter drugs including benzodiazepine tranquillisers, sleeping pills such as zoplicone - implicated in the death of Hollywood star Heath Ledger - and painkillers containing codeine.
 
The review, which began in July, was disclosed in a Westminster hall debate last June but has not been formally announced. It followed a report by the House of Commons all-party group on drugs misuse which called for better training for doctors in the risks of over-prescribing, greater awareness of the scale of addiction and more centres for treatment.

On Tuesday, Lord Montagu, the Earl of Sandwich, is to seek details of the Government review in the House of Lords and will say how the problem of addiction has impacted his own family.

He said: “Since January a member of my family has been suffering from acute withdrawal from this prescribed drug [a benzodiazepine]: his dreadful symptoms mean he is confined to his room, unable to work and attend to his family. He receives no government or medical support because there is none.” Lord Montagu said the government should take “urgent action” to help victims of benzodiazepine withdrawal and develop a network of clinics to care for them. “I would like to see direct support for people who are victims like the member of my family,” he said.

The addictive properties of benzodiazepines and similar tranquillisers, for which 11 million prescriptions were written last year, were first recognised three decades ago when the best known among them - Valium - was widely prescribed for stress. It became known as “mother’s little helper”, after the Rolling Stones 1960s hit, because GPs handed out large quantities of the pills to women trapped with small children in high rise blocks.

In 1980, an item on Esther Rantzen’s BBC TV programme “That’s Life” detailing the difficulty some people had withrawing from Valium, provoked the biggest response in the programme’s history, exposing a problem on a huge scale that had gone unnoticed by doctors. GPs had until then assumed, when patients complained of symptoms of withdrawal, that this was the anxiety returning - and prescribed more drugs. “That’s life” was later celebrated as the TV programme that changed the course of medicine.

In 1988, doctors were warned by the Committee on Safety of Medicines that prescriptions for the benzodiazepines should be limited to a maximum of four weeks . The warning was re-iterated by Sir Liam Donaldson, the Government’s Chief Medical Officer in 2004.

Campaigners say these measures have proved inadequate. The growth of on-line pharmacies, and the ease with which “legal” drugs can be obtained and used compared with the risks involved in illegal drug use, are contributing to the problem, they say.
 
Pam Armstrong, of the Council for Information on Tranquillisers and Antidepressants (CITA) in Liverpool said: “There are still lots and lots of patients being put on these drugs and kept on them for a long time. I have some sympathy with GPs - they get a lot of pressure from patients who want these drugs. But the problem has been ignored. These are patients who don’t go out mugging old ladies and creating trouble - and their needs are not being met.”

CITA has run clinics for addicted patients in GP surgeries across five primary care trusts in the north west for the last 15 years, helping wean patients off their drugs. This month the first private in-patient unit, the Sefton Suite, is due to open in Aintree, Liverpool. “We need services to be established on a national basis,” Ms Armstrong said.

A spokesperson for the Department of Health said prescribing of benzodiazepines had “declined substantially” in the last ten years.

“Misuse of any prescription medication can be extremely serious. Our main focus has been on prevention and we are currently looking at how we can further strengthen such measures. This includes reviewing prescribing guidelines and getting the full picture on over-the-counter and prescription drug dependence. We are also working closely with GPs to ensure they are fully aware of any potential side-effects from prescription drugs.”

Helpline - Council for Information on Tranquillisers and Antidepressants: 0151 932 0102
http://www.benzo.org.uk/
 

Case study: 'My life has been shattered'

Matthew (not his real name), was prescribed Efexor, an antidepressant, and Clonazepam, a benzodiazepine, to help him sleep following the failure of a business venture in 2001.

He was living abroad but returned to Britain where the prescription was continued. “For seven years I was fine. I didn’t really think about the pills, I took them as vitamins. It was something I did at the end of the day.”

Earlier this year increasing fatigue prompted him to try and withdraw from them. His doctor advised a “cold turkey” approach involving a few days in hospital, after which he would be drug free.
 
“I went in as a happy confident person and in two days I was a train wreck. I felt I had woken up in a horror film, I couldn’t walk or think and I had lost my memory. It was indescribable torture.”

Nine months on, he is still trying to put his life back together. Married with two children, he has been unable to return to work.

“I am still terrified of going outside, I can’t think straight or concentrate and I have very bad depression. Every single stimulus seems scary and heightened. It is absolutely extraordinary a prescription drug can do this to you. My life has been shattered.”

“There is nowhere for me to go for support except to other sufferers on the internet and one or two people who have set up support groups round the country.”

“I have seen several doctors since and they cannot believe my doctor kept me on these drugs for seven years. I have lodged a formal complaint about him.” 

Cannabis evidence 'was distorted'

The row over the reclassification of cannabis has been reignited after the government's chief drug adviser accused ministers of "distorting" the evidence. Professor David Nutt, who heads the Advisory Council on the Misuse of Drugs, says it does not cause major health problems.
 
He accused ex-home secretary Jacqui Smith, who reclassified the drug, of "devaluing" scientific research. The Home Office said these opinions "do not reflect the views of government". A spokesman said: "Prof Nutt's views are his own."

He added: "The government is clear: we are determined to crack down on all illegal substances and minimise their harm to health and society as a whole." It comes after Prof Nutt used a lecture at King's College in London and briefing paper to attack what he called the "artificial" separation of alcohol and tobacco from other, illegal, drugs.

The professor said smoking cannabis created only a "relatively small risk" of psychotic illness, and claimed those who advocated moving ecstasy into Class B from Class A had "won the intellectual argument".

Public concern over the links between high-strength cannabis, known as skunk, and mental illness led the government to reclassify cannabis to Class B from C last year. The decision was taken despite official advisers recommending against the change. Ministers said they wanted to make the move as a precautionary measure.

The Advisory Council on the Misuse of Drugs (ACMD) review of cannabis classification, which was ordered in 2007, was the result of a "skunk scare", according to the professor. In his lecture and briefing paper, entitled Estimating Drug Harms: A Risky Business?, he repeated his claim that the risks of taking ecstasy are no worse than riding a horse.

Prof Nutt also warned that the reclassification decision may lead to more people taking the drug.
"It may be that if you move a drug up a class it has a greater cachet" he said, adding the government's approach "starts to distort the value of evidence".

He cited research which "estimates that, to prevent one episode of schizophrenia, we would need to stop about 5,000 men aged 20 to 25 years from ever using the drug".

He said skunk has been in wide usage for about 10 years but, he claims, there has been no upswing in schizophrenia.
The professor accepts cannabis can sometimes cause mental illness, but argues it is safer than tobacco and alcohol and, overall, does not lead to major health problems.
 
Prof Nutt said: "We have to accept young people like to experiment - with drugs and other potentially harmful activities - and what we should be doing in all of this is to protect them from harm at this stage of their lives.
"We therefore have to provide more accurate and credible information. If you think that scaring kids will stop them using, you are probably wrong."

Following these comments, a spokesman for the ACMD said: "The lecture Prof Nutt gave at King's College was in his academic capacity and was not in his role as chair of the ACMD.
"We acknowledge that the lecture has prompted further debate on the harms of drugs."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/1/hi/uk/8331038.stm
Published: 2009/10/29 00:00:52 GMT



Comment

While D. Nutt might be right on the absolute dangers of alcohol, smoking and ecstasy , you have to wonder why it is that he spends his time on ivory tower examination of drug classification. Ersatz rehabilitation of a drug because it has the 'wrong classification' does not improve safety in my opinion. An abiding concern with drug classification has to be seen against his clearly observable love of drugs per se. This is the man after all who says the link between benzodiazepines and real damage has not been made.
Government thinks it reasonable to argue that a man in his position can push 'private views' which wildly differ from the official position on benzodiazepines and remain in post. It says something about how seriously government takes the protection of patient health, when it allows to thrive, a man whom it seems has dedicated his life to replacing long-standing guidance and understanding with something more acceptable to himself.
 

'Chemical cosh' drugs given to dementia patients, nurses admit
By Jenny Hope
Last updated at 7:28 AM on 07th October 2009

http://www.dailymail.co.uk/health/article-1218666/Chemical-cosh-given-dementia-patients.html

Dementia experts fear patients are being put at risk through the misuse of anti-psychotics

Dangerous drugs are being routinely prescribed to dementia victims on general hospital wards, according to alarming figures.

More than three-quarters of nurses admit such patients are being given anti-psychotic drugs - often known as the 'chemical cosh' - that double the risk of death, triple the risk of stroke and accelerate decline.

The research, revealed by the Alzheimer's Society, is the first time that evidence from nurses has highlighted the widespread prescription of drugs to people with dementia in hospital.

One in four nurses told the charity anti-psychotic drugs are being wrongly used to sedate elderly patients.

Last year MPs sounded alarm bells about the inappropriate use of such drugs for up to 100,000 people with dementia in care homes after hearing evidence that they can trigger premature death.

Campaigners claim Alzheimer's patients with behaviour problems are being 'killed' to make life easier for staff.

The Alzheimer's Society and ten leading bodies are calling for the immediate publication of a long-awaited Government review into the use of anti-psychotics.

In April health minister Phil Hope said the review would be published in May, but it has still not appeared.

Neil Hunt, chief executive of the Alzheimer's Society, said: 'The massive over-prescription of anti-psychotics to people with dementia is an abuse of human rights, causing serious side effects and increasing risk of death.

'These powerful drugs should only be used in a small number of cases. The Government must take action to ensure that these drugs are only ever used as a last resort.'
 
Rebecca Wood, chief executive of the Alzheimer's Research Trust, said: 'While the Department of Health prevaricates, thousands of people are being put at risk through the misuse of anti-psychotics. After so many delays, the Government must take swift and decisive action.
 
'By breaking its promise to take prompt action on the misuse of anti-psychotic drugs, the Government is failing the most vulnerable people in our society.'
 
Anti-psychotic drugs are not licensed for treatment of dementia but are prescribed to control agitation, delusions, sleep disturbance and aggressive behaviour.

Typical drugs used for dementia symptoms are Largactil, Haloperidol, Serenace, Stelazine and Risperdal, which were originally licensed for schizophrenia and other psychiatric conditions.

The charity's survey of more than 650 nurses and 450 nurse managers found 77 per cent reporting that people with dementia in general hospital wards are being prescribed anti-psychotic drugs 'always' or 'sometimes'.

A spokesman for the Department of Health said 'The Government commissioned an independent review of prescribing anti-psychotic drugs to people with dementia and we expect to publish it, together with the department's response, shortly.
 
'People with dementia should only be offered anti-psychotics if they are severely distressed or there is an immediate risk of harm to the person or others.'