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
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?