Preface

Much of this book is about ‘dependence’ - but that is a word that acquires meaning entirely from context. Our ‘Acknowledgements’ underline this: they are not only a record of heartfelt thanks, but also admissions of deep indebtedness and dependence. So who is behind this book - in particular, who funded it and on what terms?

The Joseph Rowntree Charitable Trust (JRCT) has supported the principal author’s work for over 30 years – always on terms that offered liberation. JRCT’s support implies no specific endorsement of this book – it signals only the Trustees’ willingness to take risks in supporting projects in line with the Trust’s general objectives. See: www.jrct.org.uk. The Trustees fund projects in many different areas, focusing on those that are “about removing problems through radical solutions, and not about making the problems easier to live with”. In relation to corporate responsibilities, JRCT “is concerned that the business practices of all companies should respect human rights and not give rise to injustice or suffering”. Trust support in this area is intended, “to achieve transparency and mutual responsibility between business, government and citizens as producers and consumers and to hold those bodies to account in the wider public interest.”

Two other UK based charitable trusts gave generous financial and moral support, at critical stages of the work on this book - The Allen Lane Foundation and The 1970 Trust. Their support also goes back for many years, again on terms that have guaranteed total independence both for us and them. They offered support and then stood back, making us entirely responsible and accountable for the work done.

Such is the difference between disabling and enabling dependencies, it seems there are no conflicts of interest to declare.

This book is the product of numerous collaborations, going back many years. That makes it so much the harder to thank everyone involved, especially family and close friends. Having the freedom to write makes almost impossible demands, on the closest relationships most of all.

Directly and indirectly, and in different ways, many people played an important part in shaping this book. Many thanks, especially to Dr. Tom Allport, Margaret Ewen, Alex Garland, Dr. David Griffith, John Guest, Brian Guthrie, Dr. Hilbrand Haak, Jaap Hardon, Lisa Hayes, Catherine Hodgkin, Dr. Andrew Herxheimer, Linda Hurcombe, Caroline Medawar, Nick Perks, David Rennie, Courtney Van de Weyer and Sir Roger Walters. Inevitably, those who worked on the draft found ideas they liked, or didn’t, and there were points of disagreement between them – but they gave indispensable help in deciding what this book should and could not say.

Special thanks are due to the directors of Social Audit Ltd, where the principal author has been employed for over 30 years. They have contributed far more than their legal responsibilities might suggest, through commitment to the general principles underlying this book. They are: Christopher Zealley (Chairman); Andrew, Lord Phillips; Anthony Sampson, Oliver Thorold, Elaine Rassaby and Maurice Frankel.

The co-authors divided responsibilities as if between pilot and navigator. Charles Medawar is layman, a specialist on medicines policy and drug safety issues with a particular interest in corporate, governmental and professional accountability. He writes, broadcasts and lectures regularly, and runs a website (www.socialaudit.org.uk) which now attracts some 500,000 visitors a year. Anita Hardon is Professor in Anthropology of Care and Health at the University of Amsterdam. She has published widely, specialising on women’s health issues and studies of medicines’ use in Asia, Africa and Europe, and teaches international courses on promoting rational drug use. She currently chairs the Health Action International (Europe) foundation board.

What has emerged from all this is a story about the promotion, regulation, prescribing and use of mood-regulating drugs, mainly antidepressants like Prozac, Seroxat and Paxil. As it unfolds a drug crisis in the making, the story develops as a picture of unhealthy dependence on corporate and professional power.

The story leads to analysis: an attempt to explain to an engaged and curious layperson the basis for thinking that, for all the triumphs and gains, pharmaceutical medicine is losing sight of health and dangerously lacking in public accountability. However, the question mark in the book title is emphatic – an invitation to make up your own mind how you find medicine and what you want it to be.

This book is in no way a guide to your medical treatment; at best it can help to explain only how and why you may be treated as you are. On the basis of your experience and what you read, you might conclude either that the control of medicines is in dire need of overhaul and rethinking, or that it is an affront even to suggest that.

Either way - or perhaps something in between - this analysis is offered for peer-review and consultation, and is meant to promote comment and debate. The authors and sponsors would welcome feedback, to help prepare the next edition of this book. This first edition is intended for only limited circulation, through 2004. A revised and popular edition of this book is planned.

Charles Medawar, Social Audit Ltd, P.O. Box 111, London NW1 8XG, UK. (charles@socialaudit.org.uk)

Anita Hardon, Health Action International (Europe), J. van Lennepkade 334-T, 1053 NJ Amsterdam, The Netherlands. (anita@haiweb.org)