Sir: Your editorial "Who should pay for the `lifestyle' pills?" (9 October) contains important misconceptions. Drugs such as paroxetine do not immediately produce benefit in social anxiety disorder. The effect builds up over a period of weeks or months, quite different from the "quick fix" treatments such as tranquillisers, alcohol or even Coca-Cola.
You label paroxetine as a "lifestyle" drug. I take that to mean drugs which have no real medical utility but simply improve the way people feel about themselves or about life. A vast amount of evidence reveals social anxiety disorder to be a pervasive and debilitating condition that disrupts all aspects of sufferers' existence over years, even decades. I think you should not trivialise sufferers by equating the only proven effective treatment with a soft drink.
The editorial does address an important issue: what is the purpose of the NHS? One of its major roles must be to reduce suffering, and I can provide with you many testimonies from patients who have suffered enormously from their severe social anxiety and who would find it very difficult to fund treatment privately were your new-look NHS to view anxiety disorders as being outside its remit. I hope you weren't suggesting that other chronic illnesses that do not respond to emergency treatment - such as arthritis, diabetes and asthma - would also have to be paid for privately?
Professor DAVID NUTT
School of Medical Sciences
University of Bristol