I'm sorry to trouble you again but, since I last wrote, I've come across two things which concern me that really don't belong in the queue that leads to Mr Alder. I'm sorry to be so adamant about asking for some comment from the CSM, but it has to be reasonable to question whether a committee with such important public responsibilities should be able to claim a right to silence that no publicly controlled body would be allowed. Knowing of your strong personal support for disclosure, I find this as regrettable as it is perplexing. So far as I know, this is the first and only time the CSM has publicly asserted independence from the MCA - but what an issue to chose.

In any case, I hope you will feel more able to respond because these issues do not relate directly to antidepressants, and the question is simple. Are you concerned about either of these possible problems enough to consider tabling them for discussion by the CSM?

1. Ritalin (methylphenidate). Prescribing levels have been soaring in such a way as to suggest extensive use beyond the licensed therapeutic indications, which are as follows:

"Ritalin is indicated as part of a comprehensive treatment programme for attention-deficit hyperactivity disorder (ADHD) when remedial measures alone prove insufficient. Treatment must be under the supervision of a specialist in childhood behavioural disorders"

Who would imagine, from the figures below, that the availability of comprehensive treatment programmes or specialist supervision has kept pace with this flow of pills?

2. Neuroleptics (relapse or withdrawal?) The enclosed paper by Tranter & Healy (1998) prompted me to look at the way in which data sheets warn about the consequences of sudden withdrawal. I found most of them don’t and that others suggest levels of risks that seem to bear little no resemblance to clinical reality. I give some details in the note enclosed. The situation seems far from satisfactory to me.

I am writing to Dr Keith Jones, but would be grateful if you could me know whether the CSM believes anything should and can be done to improve the situation.

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