Sir: Several issues have arisen out of the Department of Health's recent announcement concerning the contraceptive Pill.
The DoH lists varicose veins, obesity and previous thrombosis as reasons for discontinuing the third-generation Pills containing desogestrel and gestodene. It is firmly established that varicose veins are not a contra- indication to the Pill. One of the biggest risk factors, smoking, has not been listed.
As GPs, we are unable to comment on the actual research that persuaded the DoH to go public, as the research is not yet published. We are left impotent when dealing with patients' concerns.
The Government has been trumpeting "evidence-based medicine" as an explanation for the rationing that is occurring in the NHS. If the three studies quoted by the DoH have not been critically analysed, then this cannot be "evidence- based medicine". There are thousands of studies occurring at any one time, many of poor quality. If studies are not allowed to be challenged in open debate, then I fear we will be basing our care on rumours and scaremongering. Is this really the precedent the Government wishes to set?
The DoH sent letters to all GPs on the evening of 18 October and a press conference was arranged for the following morning. The department has taken the moral high ground by saying that it is their duty to inform Pill users as early as possible. Why then are the women advised to go and see their GPs? If the DoH wishes to involve us, it should do so in full consultation with the GP leaders. If not, then leave us out of the mess.
Both your editorial on the 20 October ("Prudence and the Pill, revisited") and the subsequent correction (21 October) contained inaccuracies. The first generation (high-dose oestrogen) Pills lead to a greater risk of thromboembolism than either the second generation (low oestrogen), Pills or the third generation (desogestrel and gestodene) Pills.
N. M. Nabi
Walker Medical Group
Newcastle upon Tyne
23 OctoberReuse content