Dear Keith,

I'm afraid I have only just received your letter of 18 September; Mr Dunlevy sent me a copy yesterday. I don't know what can have happened to the original, but it certainly never arrived here. Ah well.

Could you please clarify whether you were responding on behalf of Professor Rawlins and the Committee on Safety of Medicines, as well as for the MCA? I need to know mainly because of the bearing your letter has on the independence of the CSM and its relationship with the MCA, also because I am not clear how I should interpret what you say and don't say. There is some ambiguity on these points:

1. You wrote that decisions regarding prescribing are not a matter for the MCA or the CSM, and refer to "we" throughout your letter - indicating perhaps that you were speaking for both organisations; but

2. You also write about the role of the Licensing Authority - but without making it clear if this refers only to the MCA, or to the CSM as well - saying that its job is simply to provide authorised product information, leaving it to prescribers to make decisions. However, the terms of the CSM would permit it to go much further than this - eg to advise users as well.

3. Your letter doesn't address the central questions in my letter to Professor Rawlins - ie whether the issues I raised might be considered of sufficient importance/interest to be considered by the CSM - and whether the CSM believes anything should and can be done to improve the situation?

4. I have heard nothing from Professor Rawlins but think it unlikely there is some stack of letters from him, also lost in transit. And I am of course reluctant to accept that a QUANGO can, at whim, decide sometimes to clam up and pretend it doesn't exist, and at other times emerge from the shadows shooting from the hip.

You will appreciate the confusion that might arise here. Perhaps you could advise me on these points?

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