Thank you for your letter of 8 May. You should stop worrying about what you imagine I appear to be saying. I do chose my words carefully and wish you would concentrate on them. I note your views on innuendo in the light of the mysterious "volumes" of meaning you attach to what you see as my failure to make a referral to the Committee on Standards in Public Life. The prospect of delighting you by making a referral is certainly an incentive to write to the Committee, but I did clearly explain why I hadn't: "my mind is not closed to the idea that the CSM did all that might reasonably be expected of it to avoid conflicts of interest."

On the other hand, it would be naive to suppose that CSM members gave no thought to personal convenience or advantage (eg career development, political honours) and I believe the law is seriously inadequate. Moreover, what I understand by "the public interest" comes much closer to notions of benefit to the public, and refers to policies and activities carried on with informed consent. Here we part company. You will never persuade me to entrust the determination of the public interest on drug safety issues to a committee monopolised by doctors, buried in secrecy, close to the industry but very frosty towards consumers, when members may have conflicts of interest, walk a tightrope of temptations, and then make decisions on matters of life and death.

I welcomed your comments on the Montgomery & Dunbar paper because at least they clarify why you are confused. I shall write to you about this, at length, in due course.

On the question of the relationship between withdrawal and dependence, I am enclosing a copy of my 7 May letter to Dr Jones. The attachment will remind you what dependence meant, just a few years ago, in the days when common sense and understandings prevailed.

You are right to suggest there is a dialogue of the deaf about the paper by Price et al. I still believe it should be withdrawn and it alarms me that you suggest I am some kind of idiot to think so.

I did see the Haddad et al editorial, and responded with a letter to the BMJ. I don't know if they'll publish it. A copy is enclosed. I note these authors are completely independent of the CSM/MCA, but believe they failed to disclose a significant association with the manufacturers of Prozac.

I defer to your better understanding of the research grant process, but was not thinking of this when I said "companies also play a major part in deciding who gets to the top". I had other issues in mind - for example, whose names get around? Whose opinions get most published and quoted? Who gets invited to conferences? Who sits on committees which recommend drugs? Who picks the participants at consensus meetings where decisions are made about what should be treated and how? Who wins prizes and awards? Who get chairs endowed for them? Who flies First or Club class to fine locations? Who gets funding, commissions and fees?

In the light of what you say in your last paragraph, please would you let me know, again as a formal Code request:  [a] whether or not the CSM/MCA have considered within the last six months the need to revise data sheet warnings about withdrawal reactions with SSRIs; [b] if so, whether or not you are satisfied with them as they stand; and [c] if not, whether you have some substantial revision in mind? Discounting the possibility of any dereliction of duty, perhaps it would be appropriate not to be quite so monumentally overbearing in future correspondence. I find it quite engaging (and accept your criticism of my intemperance) but, given the authority of your office, the tone of your remarks might just cause some people, Ministers even, to believe there is not the slightest justification for my enquiries and concerns.

Yours sincerely,

Charles Medawar