HL Deb 14 April 1965 vol 265 cc479-95

6.54 p.m.

BARONESS SUMMERSKILL rose to ask Her Majesty's Government whether the contraceptive pill should be withdrawn from the market pending the investigation of the Dunlop Committee, which has thought fit to warn doctors of possible dangerous side-effects following reports of thrombosis in the brain, lung and heart of women taking the pill. The noble Baroness said: My Lords, I must apologise to the House and to my noble friend for bringing up this matter at this late stage, but he will know that it was not until the end of last week that an announcement was made in the medical Press that the Dunlop Committee on the Safety of Drugs were prepared to investigate the oral contraceptive following a number of complaints they had hadregarding certain medical side-effects which had been observed in women who had taken this drug. It seemed to me this was the only opportunity available for raising this matter before the Recess.

I consider this question of such importance that I believe some immediate action is called for. I do not think I need tell the House that I of course believe in the planned family but I believe that the health of the mother is of paramount importance when we are considering any method of contraception. To-day many women, anxious to prevent another pregnancy, resort to the comparatively new, inadequately tested, oral contraceptive. Although they are completely ignorant of the dangerous potentialities of the oral contraceptive, they embark on a perilous course of daily medication for months, sometimes for years.

This is not a question of hindsight with me. Many of your Lordships will know that this is not the first time I have raised it. I discussed it in 1962 during the course of a debate on world population, when a noble Lord in all good faith thought that we had solved the problem of over-population because an oral contraceptive had been discovered; and I spoke very strongly on the dangers to women of permitting the distribution of an inadequately tested oral contraceptive. I said to the House that not for one moment would I be so presumptuous as to suggest that my medical knowledge was sufficient to denounce this oral contraceptive. I quoted Professor Sir Charles Dodd, the eminent endocrinologist and President of the Royal College of Physicians. May I again quote just some of the extracts from the speech he made to a conference of endocrinologists, those who have expert knowledge of the ductless glands. on the subject of the oral contraceptive? Sir Charles said this: The continuous or cyclical use of these compounds may foreseeably have other undesirable effects which the trials conducted to date have not resolved. He went on: Whilst everything might appear all right on the surface, there may he deep-seated changes going on in the body. It would seem very unlikely to me that the abolition of a cyclical process such as ovulation can be accomplished over a long time without profoundly affecting other processes, and the fact that there appears to he no change for a period is not. I suggest, reassuring. I would remind your Lordships that he also said that the body was a biological clock, and if the clock goes well then do not try to interfere with it.

On September 16, 1961, the British Medical Journal uttered a warning. It posed several important questions having regard to the fact that the action of these drugs is not precisely understood. It asked: one is whether the endocrine system will become permanently impaired and perhaps fertility reduced or destroyed". Another question was whether these substances could be carcinogenic. It said: It still remains to be shown that the suppression of ovulation over long periods is harmless to the endocrine system. The Lancet joined in—this was four or five years ago— uttering a warning note. The Lancet said: The use of oral contraceptives cannot be contemplated without considerable trepidation…Twenty years may go by before we can be sure about the safety of the present oral contraceptive. On the previous occasion I suggested that the unfortunate Puerto Rican women who had been used for these first trials by the American firm producing the contraceptive pill should be carefully watched over the years to see whether these fears expressed by the experts were confirmed, before distributing these drugs in other countries. I reminded your Lordships that in many of the underdeveloped countries there is only one doctor to 100,000 population, and that to distribute these pills indiscriminately was sheer cruelty to these illiterate, ignorant and innocent women. It is a little ironic that the recent controversy within the Catholic Church regarding the advisability of birth control has been an untold blessing to the purveyors of oral contraceptives. Indeed, "The Pill" has merited capital letters in the Press. And while during the last year or two the arguments have been waged as to whether it is morally desirable, it has been assumed by the public that it is physically desirable, otherwise, presumably, the Catholic Church would not have been associated with it in the first place.

Quite understandably, the pharmaceutical industry regards the contraceptive pill as a most profitable line, and now eleven firms are producing these pills under different names, accompanied by most alluring advertising aimed at allaying the fears of the medical profession. I know that my noble friend who will he answering this question is a voracious reader of medical journals, and he has no doubt read many of the letters appearing in the British Medical Journal and in the Lancet in the last few years, drawing attention to the side effects which accompany the use of oral contraceptives.

My noble friend may care to refresh his memory. I must confess that yesterday I looked up 30 or 40 B.M.J.s and an equal number of copies of the Lancet. I am not asking him to delve too deeply; I ask him to look only at the B.M.J.s and the Lancets of this year. I would particularly draw his attention to the recent letter on cerebro =vascular accidents and oral contraceptives from Doctor Geoffrey Baines of the Newcastle General Hospital in the B.M.J. of January 16, and one on oral contraceptives and liver damage from Drs. Stoll, Andrews, Motteram and Uphill of the Peter MacCallum Clinic, Melbourne. The Commonwealth have been most interested in this question, because the subsidiaries of the American firms and the pharmaceutical firms are operating in all those countries. The letter from the clinic is in the B.M.J. of March 13.

If my noble friend would like some food for thought—I do not want to go into all these medical details—I would ask him to read the letter on some medical aspects of oral contraceptives by Drs. McLaren and Lucas of the Department of Gynaecology, the Queen Elizabeth Hospital, Birmingham. This is in the Lancet of January 9, 1965. These letters are highly technical. There are also many letters from medical practitioners. I would quote from one from a medical practitioner which serves to emphasise the sociological aspect of this matter. It was from Dr. J. H. Naysmith, and it appeared in the B.M.J. of January 23 of this year. He wrote Sir, Up until recently I have felt quite justified in prescribing oral contraceptives for my patients. However, on Boxing Day, a patient of mine, a young woman aged 33, the mother of six children, died suddenly from coronary thrombosis. She had been taking oral contraceptives for three years, and had had no ill-effects whatsoever …In fact, according to her, it was only since taking the pill that she had had any life at all. She was happy and contented, looking after her children well, and no longer waiting in fear and trepidation in case her next period did not come". He concluded by saying One cannot draw conclusions from a single case, but is there an increased risk of coronary thrombosis in those taking the pill? And if so, are we justified in subjecting our patients to this risk?". The other letters to which I referred my noble friend deal with technical medical details. I have read this rather poignant letter because it pinpoints the position of the woman who is desperately anxious not to have more children. In fact, in my post this morning I had two letters from women saying that they would rather develop any of these diseases than have another child. The woman, desperately anxious not to have more children; the doctor, in all good faith believing all the propaganda that has been put about, prescribing the drug: here we have a simple picture which can he seen all over the country—both people entirely innocent of the awful potentialities of these drugs.

It is said—and I am sure my noble friend is going to say this—that the risks are inseparable from the use of new drugs and must he taken if we are to make progress in this field. But the women who take these drugs are not suffering from some obscure disease which might merit the trial of a new drug even at the expense of a patient's health deteriorating. These are not old men or old women who have enjoyed their life's span and are prepared to have a little gamble on a new drug guaranteed to defeat old age. They are not weary, pleasure bent, middle-aged individuals, ready and willing to experiment with drugs recommended to increase the libido.

My noble friend and I know that drugs catering for these groups are sold daily for those purposes. If those groups were involved, I do not think I should come here and defend them, because they would know what they were doing, and the drugs would be quite unnecessary. If we were talking about groups of this kind my noble friend could argue that the element of risk could be disregarded —that any old person who is anxious to prolong life and may risk taking a pill or drug, after all, has enjoyed his life, and the community will not suffer. But the people who are exposed to the risk of serious disease or death itself from taking the oral contraceptive are healthy women in the prime of life, mothers charged with the responsibility of bringing up their children and caring for their families. Indeed, they represent one of the most important and valuable groups in any society, whose health should be safeguarded and afforded the maximum protection by the State. Indeed, it has always been our social policy.

I remember in 1918, when the maternity and child welfare clinics were set up, listening to speeches on what should be a duty of the State, and hearing that one of the primary duties in the field of health is to protect the mother and the children. Is there to be no limit placed on the number of young, healthy women who are to be exposed to this serious risk? Have we learned nothing from the thalidomide tragedy? May I remind my noble friend that the children of the United States did not suffer from the thalidomide tragedy because there was a wonderful woman doctor in the Food and Drugs Administration who said, "This drug has not been properly tested, and American women shall not have it". Representatives of the pharmaceutical in dustry got up and said, "This woman is a stupid ass. She does not know what she is talking about." She stuck it out. She stuck out against the most appalling ridicule and the most awful attack in the United States from the pharmaceutical industry, which is one of the strongest in the whole world. Nevertheless, having stuck it out, the result was that only two or three children in the whole of the United States were affected as the result of mothers taking thalidomide.

My noble friend may say that a woman may have a thrombosis or a diseased liver or cancer of the breast without taking the pill, and therefore the condition could be coincidental. But the fact is that the volume of correspondence from doctors and the number of cases brought to the attention of the Dunlop Committee on the Safety of Drugs has at long last compelled them to initiate an inquiry. I was surprised when I opened the Daily Maii and the Daily Telegraph to-day to see three or four cases mentioned. The other thing my noble friend will say—because I can see right into his mind, even through the back of his head—is that still the number of cases is not overwhelming. But they said that about thalidomide. They say that about all these drugs which have not been adequately tested, when a complaint is made of a side effect.

If we ignore this, what of the long-term effects? The Lancet has said that twenty years may have to elapse before we can be sure of the safety of the oral contraceptive. Then let us wait and see what happens to the poor little Puerto Rican women who were given it nearly ten years ago. After all, it cannot be argued that there is no alternative to this method of contraception, and that despite the risks we must use these pills for women who want to limit their pregnancies. There are on the market many harmless, well-tried methods of contraception which afford a high degree of protection. Therefore surely the time has come to call a halt to the distribution of these drugs, which are highly suspect, until the Dunlop Committee issues a Report on the result of its investigation.

7.12 p.m.

BARONESS GAITSKELL

My Lords, I am going to intervene very briefly on this matter, disagreeing fundamentally with my noble friend Lady Summerskill I feel at a great disadvantage as compared with my noble friend, for I am not a doctor and I have a bad memory—although I have heard several eminent doctors speak very much in favour of the pill, I cannot remember their names. I very much hope that the pill will not be withdrawn, always assuming that research will go on the whole time and that the matter will be looked at very carefully in relation to all the side effects. To date, although there has been correspondence on the matter and although there may have been cases of thrombosis brought to light, I do not think it is at all clear that these cases are due to taking the pill. The pill has been taken for at least ten years and has been watched over by the Family Planning Association for at least that period of time. The percentage of women in the United States who take the pill is very great. Although they did not take the thalidomide drug they certainly have taken the oral contraceptive, and I do not know that there has been any kind of inquiry there as to the side effects.

BARONESS SUMMERSKILL

My Lords, may I remind my noble friend that in the United States there is a prohibition after two years. They feel very strongly about it.

BARONESS GAITSKELL

But I know of women who have taken them for much longer than two years, so the cases where it has gone wrong would appear to me to be very few. A week ago I saw on television a doctor discussing the side effects, but he produced absolutely no figures and did not say that there were even three or four cases; he simply hinted that there might be side effects which included thrombosis. I believe that there is no dramatic incidence of thrombosis which can yet be proved. Certainly the letter which my noble friend read out is not at all conclusive. The woman had had six children and she might have contracted coronary thrombosis through any cause whatsoever. After all, there are many cases found in women after childbirth.

Before we go ahead and get rid of this pill, which I think has very good effects in the developing countries where women are very poor, where they have large families and suffer enormous hardship and unhappiness, we ought to consider very carefully the figures involved and make a comparison of cases of thrombosis after childbirth with cases of thrombosis after taking the pill for a number of years. In any case, we must put all the risks of taking the pill against all the risks of excessive childbirth from too frequent pregnancies. When one considers the Puerto Rican or Indian women who go on having child after child and end up with enormous families, their children being brought into the world to starve or, if they survive, never to get a job in later life, we must balance those matters against the dangers of the pill. So far I do not think that there is sufficient evidence to show that the pill is really dangerous. I hope that research will go on, and will go on for at least twenty years, and more if necessary. I hope that a contraceptive pill will be evolved, that it will be a pill for men rather than for women, and that it will be proved safe. It seems to me that in certain poor countries this is the only hope we have for happiness among such people.

7.16 p.m.

LORD FERRIER

My Lords, I have been most interested in the speeches which have been made, and I hesitate to intervene for I have no prepared speech; but the noble Baroness, Lady Summerskill, rather swept me into the matter when she made reference to the pharmaceutical industry. In that respect I have only one point to make. The noble Baroness, Lady Gaitskell, said that her memory is not too good. Mine is terribly bad, but it happens that I have with me a note about the occasion which she mentioned—a broadcast on the 9th of this month, when a Professor Witts, who is a very well known authority on the subject, made reference to points involving experience in America. He said that two or three inquiries had taken place in the United States. He stated: One, in 1963, in relation to food and drugs administration, which corresponds rather with our Committee"— I think he was referring to the Dunlop Committee— said quite directly that they had not been able to find any evidence that the women on the pill were getting thrombosis more commonly than women who were not. Later on he said: We have no reason to believe that thrombosis is more common on one pill than on another, and have no reason to believe that it was more common in women taking the pill than in women who were not. As a matter of fact, I am here not really in a dual capacity, because I am no longer concerned with the pharmaceutical industry but am Chairman of the Scottish branch of the International Family Planning Campaign. Knowing the importance of oral contraceptives, I thought that I should sit here and listen to this debate. I would make the point that the noble Lady's Question talks about "withdrawing" the pill from the market. I take it she refers to this country. If she does, it is fair to point out that the pill is obtainable in this country only on prescription. I have no doubt that the noble Lord who is going to reply will make that point.

I am of an open mind, despite what Lady Gaitskell has said, and despite the tremendous advantage of oral contraceptives in connection with problems which face women in Puerto Rico. I have no personal knowledge of this and I am still of an open mind as to whether, as time goes on, it will be found to be the right answer to the problem, having regard to possible side effects. Therefore, I am in a measure of agreement with the noble Lady on this point. But it is fair to make clear the point that in this country the pill is obtainable only on prescription, and that if, indeed, the medical profession has any reason to doubt the wisdom of its use, then the solution is for the medical profession to prescribe it Less.

BARONESS SUMMERSKILL

My Lords, may I just interrupt the noble Lord, as I want to make this point quite clear? Yes, the medical practitioner can prescribe it on an EC.10 for medical reasons, but he can also give a private certificate to any woman who asks for it for social reasons. So there is really no limit, so far as prescription is concerned. He cannot use an EC.10 for social reasons but he can give an ordinary certificate.

LORD FERRIER

My Lords, the noble Lady is, of course, quite correct. My point is that the pharmacist is not allowed to supply it except against a prescription by a medical practitioner. If, in the event, the Government, the medical authorities or the Dunlop Committee are satisfied that this pill presents any dangers, then the remedy is to make doctors hesitate to prescribe it. I agree very much with what the noble Baroness, Lady Gaitskell, said—this is based on information I have recently had privately from India—that the oral contraceptive seems to offer a more practical way of limiting families, and enabling parents to plan families, in backward countries than any other. I look forward with great interest to the noble Lord's reply.

7.22 p.m.

THE PARLIAMENTARY UNDERSECRETARY OF STATE FOR COMMONWEALTH RELATIONS AND FOR THE COLONIES (LORD TAYLOR)

My Lords, my noble friend Lady Summerskill has made it absolutely clear that she does not like the pill, and it is not the first time that she has made this clear. There is some risk in every human action that we take; certainly in every drug that is administered by a doctor. There is a risk in giving aspirin. it may in some susceptible people cause gastric haemorrhage. There is not a single medicament which can be administered and which is completely free from risk, and it is part of the doctor's job to evaluate both the benefitsand the risks and to reach a sensible and reasonable decision on theevidence, available. That is what every doctor has to do. That is the responsibility which he takes when he prescribes any medicine at all, and that is the responsibility which every doctor takes who prescribes an oral contraceptive, whether on an EC.10 or on an ordinary piece of notepaper. He must have evaluated—if he is an honestman; and I assume that all doctors are honest men—the risk to his patients and the benefits obtained.

Nevertheless, it is a very difficult thing to evaluate both the risks and the benefits. Of the two it is easier, usually, to see the benefits, because the risks of harmful effects from any drug are very slight indeed. They are of an incidence of one in 1,000 cases, one in10,000 cases, or even less. It is an extremely difficult matter, therefore, to be certain that one is not arguing post hoc ergo propter hoc; because something has happened, therefore it was due to the preceding event. That is one of the commonest mistakes that we make in medicine. We assume that because we have given a medicine and the patient gets better, it is because we have given the medicine. For years fallacies have persisted in medicine for exactly this reason.

My noble friend has phrased her Question in a peculiar way. She asked whether the pill should be withdrawn from the market pending the investigation of the Dunlop Committee, which has thought fit to warn doctors of possible dangerous side-effects following reports of thrombosis in the brain, lungs and heart of women taking the pill. I must say that, as I listened to my noble friend, I could not help contrasting her observations with the way that the Press in general—and I have read all the Press cuttings—dealt with this letter from the Dunlop Committee to the medical journals; and I must say I thought they dealt extremely responsibly with it: Doctors to make birth pill check. A birth pill probe: is it dangerous? There were very sensible balanced articles, and I think they were right. I am quite sure that the Dunlop Committee is an extremely wise Committee, and for me to pit myself against it would be silly. When one considers the collective wisdom of the people on that Committee, one must be bound to take its advice very seriously.

I do not think my noble friend Lady Summerskill has really understood the purpose of the Dunlop Committee in sending this letter to the medical journals, and perhaps I can best make that clear if I read the letter as it appeared in the British Medical Journal and the Lancet last week: Thrombotic disease occurs occasionally in young women of child-bearing age. It is, therefore, to be expected that it will occur in women who happen to be taking oral contraceptives. Some cases of arterial thrombotic or thrombo-embolic episodes in women taking oral contraceptives have been reported to the Committee on Safety of Drugs. Incidentally, it has certainly taken into account all the letters to which the noble Lady referred. The letter continues: It may well be that these do no more than reflect the normal incidence of such conditions in women of child-bearing age and the Committee wish to stress that there is no evidence of a relationship between the use of oral contraceptives and these events. In accordance with their usual procedure for following up reports of suspected adverse reactions to drugs, the Committee are seeking to establish the relative frequencies of such incidence in women who are taking oral contraceptives and women of the same age who are not. To help the Committee in their study, doctors are requested in cases of arterial or venous thrombosis or pulmonary embolism in women of child-bearing age to take a careful drug history, including whether or not the patient has been taking an oral contraceptive, and to notify the Committee on Safety of Drugs if an adverse reaction to any drug is suspected. Your Lordships will see that the Committee are at great pains to explain that there is at present no evidence to suggest a cause-and-effect relationship between these terribly sad incidents and the fact that the women concerned were taking the pill. They do not know, and it may have been no more than a coincidence. With proper scientific objectivity they point out that thrombosis does occur in women of child-bearing age, whether or not they are taking oral contraceptives, and that the incidents reported to them may represent no more than the general incidence.

My noble friend mentioned the investigations of the Food and Drug Administration in the United States and praised their work, quite rightly, on Thalidomide. They have, in fact, investigated one of the oral contraceptives over a very large series of cases, and they reached the conclusion that there was no significant increase in the risk of thrornboembolic death from the use of one of these oral contraceptives. There were cases reported in both series—both patients who had been taking the drug, and patients who had not been taking thedrug—and therefore the matter is still an open question.

As part of their procedure in studying adverse reactions to drugs inuse, the Committee have asked all doctors in 'the United Kingdom to report to them any condition which may be associated with the use of any drug, and every doctor is supplied with a set of cards on which he can send a brief report. I have no doubt that my noble friend is familiar with this little card which is issued by the Committee to every doctor. If he has any patient in whom he suspects an adverse reaction due to a drug, he fills in the name of the drug, how long the patient has been on the drug, the daily dosage, the suspected reaction, and the name, age and sex of the patient, so that the patient can, if necessary, be visited by the assessor or adviser to the Committee on Safety of Drugs.

As a matter of fact, the Committee have told my right honourable friend the Minister that they are getting a very big response from doctors. They get over 100 a week of these cards coming in reporting adverse reactions to drugs. My Lords, it would be quite ridiculous to suggest that, because adverse reactions to a drug have been reported, it should automatically be withdrawn from the market. It is only as the picture is built up gradually that any final decision can be arrived at. The Committee call this system of reporting "the early warning system". That is a good name, in a way, because it indicates what it is intended to do, which is to alert the Committee to possible hazards in the use of drugs; but it is a bad name if it suggests that this is necessarily an early warning to the medical profession or to the public lin General. The Committee are careful to explain that, essential as it is to draw their attention to something which might need further investigation, it does no more than that.

My Lords, the difficulty is that adverse reactions to drugs are hard to identify and confirm. Normally, they are of the same nature as conditions which occur without any drug in ordinary nature. Therefore, any observed incident or condition may have nothing whatever to do with the drug that has been given just previously. It is only when a report, or a series of reports, is looked at, in conjunction with other reports on the same drug, that it can be regarded as an early warning to the Committee; and for this reason the Committee have encouraged doctors to report any reaction which could possibly be suspected of being associated with the use of a drug. They are quite aware that they are bound to receive reports of suspicions which will prove groundless. They cannot afford to leave any alert unheeded, and all reports of serious or unusual reactions suspected of being associated with drugs trigger off a procedure for follow-up to see if the thing is a "true bill", as it were.

There are various procedures available to the Committee, and each investigation is specially designed for the circumstances. But the common objective of these investigations is to determine the incidence of the condition in persons who are not receiving the drug, as compared with people who are receiving the drug; and only when these figures show a significant difference can the Committee assert with confidence that a drug is or is not to blame. This is really an essential scientificprocedure if the hazards associated with the use of drugs are to be properly evaluated, because it might be more serious to condemn unjustifiably a valuable drug and to deny patients its benefits than to allow a drug with a low incidence of serious reactions to remain in use.

In the case of most drugs, this is all done without publicity. The Committee are enabled to carry out their investigations by taking samples of National Health Service prescriptions and asking the doctors who wrote them if they have observed the adverse reactions reported under the early warning system. They can also obtain from National Health Service statistics a reasonably accurate figure of the number of patients taking a drug. I think it is an advantage of the National Health Service that it offers facilities for carrying out investigations of this sort which are not available anywhere else in the world.

Unfortunately, because the majority of prescriptions for oral contraceptives are private prescriptions, as the noble Baroness pointed out, the Committee cannot so easily follow up the reports about them which they receive under the "early warning system." They are working out some special procedures aimed at discovering if there is a greater incidence of thrombosis in women taking the pills than in comparable women who are not taking them. This is, however, a very difficult investigation, and the medical assessor to the Committee has mentioned to the Press that it may take two or three years before a final decision can be reached because the incidence of these conditions is, fortunately, very low, anyway: and, just as the noble Baroness has said, the final determination of the results of continuous treatment of any kind can be determined only over many years.

LORD FERRIER

My Lords, may I interrupt the noble Lord at this point? I said that I personally had worries about this. One of the worries I have had—and, when the noble Lady talked of 20 years, it made me think of it—is whether the use of the oral contraceptive, particularly in rather young women, might in later years render the woman sterile, unable to bear children; and whether it might be the case that this Committee could start doing the ground work now, by perhaps setting up some sort of early warning system, for something which may be years ahead.

LORD TAYLOR

I can only say that the evidence, such as it is, such as I have been able to ascertain it, is rather the reverse: that, after stopping oral contraception, fertility is, if anything, slightly increased.

BARONESS SUMMERSKILL

My Lords, may I interrupt? I do not know where my noble friend got that information from. Everything I have read about it suggests that after a woman has been without children for a number of years it is a most difficult thing to persuade her to experiment and find out whether or not she is fertile. And she can find out whether or not she is fertile only by having another baby.

LORD TAYLOR

There is something in what the noble Lady says. Nevertheless, it sometimes happens that people want to plan their families and space them out, and the evidence obtained by the Family Planning Association—

BARONESS SUMMERSKILL

But the noble Lord spoke of many years ahead.

LORD TAYLOR

I cannot speak about many years ahead: I can speak only as to a period of about two years. After a period of about two years it appears that fertility is, if anything, slightly increased, rather than diminished.

I was explaining that in the great majority of cases these drugs are not covered by National Health Service prescriptions, and for this reason the Dunlop Committee decided that they had to take another step. They have told my right honourable friend that they had some fears that their purpose in writing to the journals might be misunderstood, as indeed it has been misunderstood by my noble friend. They thought this would be most unfortunate, because, as they made so abundantly clear in their letter, they had no evidence to merit any indictment of oral contraceptives. Nevertheless, they felt that, in spite of the publicity which is inevitably associated with anything connected with the pill, they should take the action which the reports under the "early warning system" called for. Here again, I would emphasise that one must be impressed by the responsible way in which the Press dealt with this letter to the medical journals. I think no reader could miss the point that the Committee made: that there was nothing known at present which called for the condemnation of the pill.

I was most grateful to my noble friend Lady Gaitskell for her useful contribution, in which I was very interested, and particularly for the emphasis which she placed on the value of this particular form of contraception in developing countries. I think we must be very careful indeed to make sure that, before we make vigorous and alarming statements, we have the evidence; and the evidence, so far as I can judge, is so far just inconclusive.

The noble Baroness, Lady Summerskill. refers in her Question to a warning by the Dunlop Committee. I hope it is clear that the Committee have not thought fit to issue a warning to the medical profession. If, during their investigation, they come across anything which calls for a warning, I know that they will not hesitate to advise my right honourable friend, for this is one of the purposes for which they were appointed. Her Majesty's Government have the fullest confidence in this Committee. It really is a very eminent Committee. One has only to look at the pharmacologists, the professors of medicine, the professors of therapeutics and anesthetics who sit on it, including Professor Witts whom the noble Lord, Lord Ferrier, mentioned, who is Chairman of the Sub-Committee on Adverse Reactions which is particularly concerned in this matter.

My Lords, these are responsible people, and they would not risk either their patients' welfare, or any patient's welfare; nor, indeed, would they risk unscientific statements. Her Majesty's Government have full confidence in the Committee and they are assured that the Committee do not consider that these drugs should be withdrawn during the investigation.