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NEWS: Owen Dyer GMC finds three doctors guilty of irresponsible prescribing to addicts BMJ 2006; 332: 747-c [Full text]

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Hindsight, foresight, Nemesis

Woody Caan   (7 April 2006)

Hindsight, foresight, Nemesis 7 April 2006
Woody Caan, Professor of public health Anglia Ruskin University, Chelmsford CM1 1SQ, UK. Send response to journal: Re: Hindsight, foresight, Nemesis	As the Greeks knew so well, Nemesis is wrapped in the mask of tragedy. Patients (who may have been desperate for help) received "innappropriate and irresponsible" care and at least one died [1], others' hopes were dashed and families grieved. Could this have been foreseen, long ago, by many colleagues and patients of these doctors? In the early 1990s I was working in the area of cocaine dependence [2]. I met a consultant who was beginning to treat his private patients using cocaine, with monoamine oxidase inhibitors [3]. I implored this doctor not to continue such an innappropriate and irresponsible treatment, detailing the pharmacology that predicted its high risks. This evidence fell on deaf ears, so later when the Royal College of Psychiatrists sent me the manuscript of a book on addiction edited by the same person I looked for potentially hazardous content (lacking evidence of any balancing of risk and benefit) and consequently recommended rejection. My recommendation seemed to fall on deaf ears, although today I was interested to observe on a careful search of the Royal College of Psychiatrists' publications website that the published book [4] seems to have disappeared from all their listings. Fortunately, performance of a Greek tragedy was always followed by a comedy (usually with lewd satyrs cavorting). Just after I read the news of the GMC decision [1] on the BMJ website, I happended to meet with several social work colleagues. Dr. Brewer came to early notoriety for his 1980 book 'Can Social Work Survive?' [5] in which he answers that question with a resounding No. The resilient survivors from social services, hearing the GMC news, did undertake some gentle cavorting. 1 Dyer O. GMC finds three doctors guilty of irresponsible prescribing to addicts. BMJ 2006;332:747, doi:10.1136/bmj.332.7544.747-c 2 Strang J, Johns A, Caan W. Cocaine in the UK - 1991. British Journal of Psychiatry 1993; 162: 1-13. 3 Brewer C. Treatment of cocaine abuse with monoamine oxidase inhibitors. British Journal of Psychiatry 1993; 163: 815-816. 4 Brewer C (Ed.). Treatment options in addiction: medical management of alcohol and opiate abuse. London: Royal College of Psychiatrists, 1993. 5 Brewer C. Can Social Work Survive? London: Temple Smith, 1980. Competing interests: Reviewed one of his manuscripts for the Royal College of Psychiatrists (Gaskell)