Dear Mr Woolf
Thank you for contacting us regarding the Panorama investigation ‘A Prescription for Murder?’ as shown on July 26 on BBC One.
We’ve received a range of feedback on various aspects of the programme. We appreciate that it's a sensitive issue and have carefully monitored viewer reaction.
To allow us to reply promptly, and to ensure we use our TV Licence fee resources as efficiently as possible, we’re sending this response to everyone. We’re sorry we can’t reply individually, but we hope this reply from the team involved will address most of the points raised.
We took great care from the beginning of the film, and throughout, to ensure viewers were aware that these adverse side effects only apply to a small minority of patients, and that they are safe for the majority of people who use them. We made clear in the film that they help many and can be lifesaving.
Some viewers were concerned that we did not highlight the risk of sudden withdrawal sufficiently. However, not only did the reporter directly say in her script that doctors advise patients not to change or stop their medication without advice, this was repeated three times in a bottom of the screen subtitle and by an announcement at the end of the programme. One of the psychiatrists featured in the film, Professor Peter Tyrer of Imperial College London, described the risks of abruptly stopping SSRI medication, and we had an Actionline number and website at the end of the programme which gave viewers contact numbers of organisations that could give them further advice.
We do not accept that the film was either irresponsible or inaccurate journalism.
The film was balanced with a range of psychiatric opinion both in the US and UK. We heard from four psychiatrists in the film: the Colorado Court psychiatrist Dr William Reid who concluded at the end of the film that the medication had played no part in James Holmes' killing; a psychiatrist hired by the Prosecution, Dr Phillip Resnick, who believed the drug may have played a part in the planning but not in the final act itself; Prof Peter Tyrer from Imperial College London who believes the drug may have caused or contributed to the killing; and Prof David Healy from the University of Bangor who was hired by the Defence team and who believed the killing wouldn't have happened without the drug.
We included a response from the two pharmaceutical companies whose drugs had been referred to. And we also heard from the prosecution attorney George Brauchler who declared “I don’t think the medications caused these shootings, I think this guy with his evil thoughts, having concluded that he had no other alternative future, with the mental illness, led to this.”
The James Holmes case was a complex case which we explored in some detail and concluded at the end that while the timeline of events suggested that his mental health deteriorated while he was on Sertraline, we will never know for sure what caused him to murder.
While the film did not claim to have scientific proof of a causal link, we believe that there is enough evidence to examine the subject further. With more and more people prescribed SSRIs, we believe it is in the public interest to understand more about the side effects that might affect a small minority. It was patient experiences reported to us after our previous Panorama investigations about withdrawal problems, about self-harm and suicide that actually helped effect a change in the official guidance about the way SSRIs should be prescribed, particularly to children and young people, as well as an overhaul of the MHRA’s Yellow Card reporting system (which previously would only take reports from doctors or drug companies, not patients).
Rare and uncommon side effects are acknowledged in the patient information leaflets of these drugs, but are rarely discussed. Rare and uncommon side effects are acknowledged in the patient information leaflets of these drugs, but are rarely discussed. In the case of sertraline, the SSRI mainly featured in the film, ‘psychotic disorder’, ‘abnormal thinking’ and ‘aggression’ are listed on the patient information leaflet as possible side effects. These warnings are based, in part, on case reports the manufacturer Pfizer has received about patients who had problems on their drug. On their own analysis of 13 case reports of psychosis when the drug was first used, in five cases they could find no other obvious cause than their drug. It is in the public interest to have more understanding and discussion of possible adverse side effects which may help people watch out for troubling symptoms.
We do not accept that our film contributes to increasing the stigma of mental health in any way. Far from perpetuating the myth that mental illness equals violence, we said quite the opposite; that these rare but devastating outcomes might not have happened had there been better awareness of potential drug side effects among patients and doctors. The suggestion that a prescription drug may have a toxic side effect for a small minority of patients does not in any way imply the patients are to blame.
We explored in some detail the expert opinion that agreed James Holmes’ initial mental health problems (intrusive thoughts and social anxiety) did not make him dangerous and that his delusional thoughts of killing only began after he started on the medication.
In conclusion Panorama investigated an important subject seriously and responsibly and it is in the public interest to examine the possible link between SSRIs and extreme side effects for a small minority of people.
We hope this addresses the main areas of concern for you. We do appreciate the time you’ve taken to get in touch.
BBC Complaints Team www.bbc.co.uk/complaints