Dear Dr. Costa e Silva,

I am writing to ask if you could let me have some information about the work of your Division, particularly in relation to antidepressant drugs. Though I have been involved in various WHO drug policy initiatives, I think it might help to avoid any misunderstanding if you could treat this as a press enquiry. I hope to report on these issues on our website within the next week or two.

This website was launched in February and is now attracting about 3,000 visits a month - a fair number, considering the very specialised subject matter. The site is overwhelmingly about drug treatment of depression, and related policy issues; the whole thing is based on a paper published late last year in the International Journal of Risk and Safety in Medicine, (Dukes MNG, Ed), a copy of which I am sending with the confirmation of this Fax.

I apologise for adding to your workload, but this was only after doing my homework. I have recently spent some time on the WHO website, but was not able to get all the answers I need. The questions outstanding are as follows:

1. I understand that WHO Mental Health Division has recently arranged for informal consultations "to analyse the current situation concerning psycho-pharmacological agents", involving experts in psychopharmacology including representatives of WHO collaborating centres in this field. Could you please tell me about the terms of reference of this group, the list of participants, and the dates they are expected to meet and report? Is this a routine meeting, or were there any particular reasons for convening the group now?

2. Could you please let me know if the meeting(s) of the group will be open to observers, including consumer/user representatives, and whether participants are inviting evidence from outside?

3. Please could you let me know what arrangements are made for the declaration of possible conflicts of interest by individual participants, and whether these are publicly disclosed? If so, please could you let me have details of any declarations made by individual participants, and any relevant information about sponsorship of the consultation itself?

I would be grateful if you could also refer me to any WHO rules and/or Divisional documents which address the problem of possible over-dependence or conflicts of interest which might arise. I ask this because the Mental Health Division receives significant support from the industry, also because I think about half the Division's work is funded by "extra-budgetary contributions", proportionately much more than other Divisions in WHO.

My particular interest is in (direct and indirect) contributions from the pharmaceutical industry and my main concern relates to the $2 million/year or so in donations the Division now receives from Eli Lilly & Company, Pfizer Inc and SmithKline Beecham, as their products dominate the SSRI antidepressant market. I realise these amount to only a small proportion of extra-budgetary contributions, but they are still among the largest company donations the Division receives.

I would be grateful for this information. Many thanks and I look forward to hearing from you.

Yours sincerely,

Charles Medawar

 

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