Dear Keith,

RITALIN AND NEUROLEPTIC WITHDRAWAL

Thank you for your letter of 20 November.

I was interested to hear of the stalwart diagnostic efforts of paediatricians, psychologists, child psychiatrists, teachers, parents and GPs in relation to ADHD and have no doubt this has contributed to the 15-fold increase in Ritalin prescribing, over the past four years. I'm afraid what you said did nothing to muffle the extreme ringing of alarm bells, but I do accept that the terms of the Medicines Act 1968 critically limit your ability to question what is at the forefront of my mind. Where do teachers and parents get these ideas from, where does health come from, and what kind of a society are we clinging to?

I still can't work out whether the main question I asked about neuroleptic withdrawal is one for you or Professor Rawlins, but I've been waiting three months for an answer. To paraphrase: is it or is it `not acceptable that 13 out of 23 data sheets for neuroleptics do not warn prescribers that "withdrawal of drug treatment requires careful surveillance because the patient who appears well on medication may suffer a disastrous relapse if treatment is withdrawn inappropriately"? (BNF).

I was asking if you are satisfied? By saying you "will comment further, if necessary", when Tranter & Healy's paper is published, suggests to me either that you are satisfied, or that you entirely missed the question. I would not want to make a formal complaint of it without knowing which, though I think I might be entitled to either way.

The point of the question has nothing to do with the value of data sheets - I am sure most doctors ignore them. It is about the competence of the Licensing Authority, given that its role (in your own words) "is to provide information to the prescriber about the safe use of a medicine by means of the authorised product information, in order that they make take this into account when making prescribing decisions".

Thank you, in advance, for your most focused attention.

Yours sincerely,

Charles Medawar

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