Anatomy of a Pill scare

ANOTHER VIEW

The recent warnings about certain oral contraceptives raise important issues about informing doctors and patients of the risks of their medicines. As Chief Medical Officer, I was closely involved in the decision and the subsequent action taken to make women and their doctors aware of the situation.

The overriding concern was that of public health and the safety of women taking the contraceptives in question. At no stage were financial considerations an issue.

Three independent studies, carefully reviewed by the Committee on the Safety of Medicines, have demonstrated that oral contraceptives containing the progestogens, desogestrel and gestodene, are associated with twice the risk of venous thrombosis as compared with other oral contraceptives that are available. Yet the committee has been criticised for acting prematurely on the basis of as yet unpublished information.

Although the risks of oral contraceptives are small and their benefits considerable, it is clearly vital to inform women and their doctors as quickly as possible of important differences in the risks of the various types of oral contraceptives available so that they can make an informed choice.

Some doctors have been concerned that they did not receive information before coverage in the press. Considerable efforts were made to inform them. Three routes of communications were used: letters sent by first- class mail to arrive on 19 October, a fax to all directors of public health, who had beenwarned 12 hours beforehand to expect urgent information requiring immediate onward transmission to GPs and hospital doctors, and finally, faxes to hospital drug information pharmacists.

We regret that despite all these efforts, the broadcast media were informed - by one of the recipients of the letter, we understand - early on the morning of 19 October, before all the doctors had received the information. In reality this sort of problem cannot be avoided.

I am grateful for the way GPs and family planning doctors have responded and put the interests of women first. It is so important that we all co- operate to make this possible.

Crucially, the advice to women must be clear. The risks of all oral contraceptives are small, the risks of pregnancy far higher. If you are taking a pill not containing desogestrel or gestodene there is no cause for concern. For those who are taking oral contraceptives containing desogestrel or gestodene it is important to carry on with your current course and contact your doctor before its completion to discuss the options for change.

Such incidents will happen again and there will be a need to respond rapidly. Co-operation between the media, the professions and the department is essential to get clear public health advice speedily to those who need it.

The writer is the Government's Chief Medical Officer.