Dear Mike,

Thanks for your letter which arrived yesterday. I too was conscious that you had not been in touch during the past four months, but thank you for confirming what Keith Jones told me in his letter of 18 September.

Call me jaundiced, but I am hardly pacing the office, anxious to learn what the MCA thinks about neuroleptic withdrawal reactions. I've found that the only way to survive this correspondence with them is keep expectations very low. Hearing from the MCA is barely an improvement on hearing bugger all from the CSM all the time, though the verbiage is sometimes interesting, and there's always something to read between the lines. They are masterly when it comes to concealing lack of evidence and information. So refined.

I was concerned, but not surprised, that you had nothing to add to what Keith Jones said about Ritalin. But are you really sure that your policies are indistinguishable, that the CSM doesn't take an independent view? To paraphrase in Plain English, this is what I understood Keith Jones to be saying: "The MCA has no comment about the 15-fold increase in methylphenidate prescribing in the past four years. From this we invite you to infer that no news is good news, that all is well. You may think there is an obviously increased risk of children being mistreated with Ritalin, but we couldn't possibly comment. This not a matter for us; we follow orders. Our job is defined in law - we advise prescribers what to do and it's up to them to do it."

It's all so far removed from what the public would expect of a policy on 'the safety of medicines', I sometimes don't know whether to blush, cry, or scream.

With mixed feelings,

Yours sincerely,

Charles Medawar

 

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