Intended for healthcare professionals

Rapid response to:


Survey of unlicensed and off label drug use in paediatric wards in European countries

BMJ 2000; 320 doi: (Published 08 January 2000) Cite this as: BMJ 2000;320:79

Rapid Response:

Les Miserables

Most people in developing countries equate developed western
countries with the epitome of scientific progress and ethical medical
practice. In India one often hears the phrase, "that would never happen in
the west". So when one reads that two-thirds of children in European
hospitals receive unlicenced drugs (1) one is petrified with disbelief.
And more so because of the realisation that the 624 subjects in the report
were from countries like Sweden (from where the Nobel Prize Awards are
distributed), UK (from where most of modern medical and nursing practice
orignated), Germany (where most of the multinational drug firms have their
bases), Italy (from where the Vatican dictates to the conscience of the
people) and Netherlands (which houses the International Court of Justice).

Church (2) expresses an even stronger observation that newborns are
prescribed drugs that are only tested in animals. In general, clinical
trials are not done on children and it is considered unethical to use
children as mini guinea-pigs (3). And, as Abraham emphasised (4) there
should be a transparency and accountability in medicines recognition in
the UK.

But children do not seem to be the only ones who are les miserables!
It is claimed that at one time 70% of doctors treating medicare patients
in the US failed in an examination concerning their knowledge of geriatric
prescribing. Also, 22% of geriatric patients who were given three or more
prescriptions upon discharge had prescription errors that were serious or
life-threatening (5). So what was reported from European hospitals was
also confirmed in the US, but to a different scale and with a different
target group.

Does such statistics reflect the corruption within a health-care
system or the failure of the medical educaton process? Indian was often
considered to be the medical dump-yard where drugs which were banned or
bannable in other countries were promoted by multinational drug firms
through their outlets here. The scenario has now changed to a large
extent. But the tragedy remains - unlicenced drugs are being manufactured,
promoted and dispensed unashamedly! Perhaps, as Klein suggested, there is
a nexus between the markets, politicians and the NHS (6).

A more gruesome view of this report would be obtained is we were to
combine the statistics of the geriatric and the pediatric prescriptions:
it might be horrific to even imagine that practitioners of modern
scientific medicine might be involved in a large-scale calculated and pre-
meditated carnage, a holocaust which is being fully endorsed by the
depraved mind that wishes to satisfy itself with monetary gains and fully
subsidised by a health care system that is more concerned about systems
than about health care.

But all is not lost. With the startling statistics being made public
it is hoped that common sense and uncompromising policy-makers will
prevail. As Lord Mountbatten said at Strasbourg in May, 1979, "it is not
science fiction, it is a matter of fact. The world now stands on the brink
of the final abyss. Let us all resolve to take all possible practical
steps to ensure that we do not, through our own folly, go over the edge".
Mankind is on the brink of its own annihilation. Only God above can save


1. Conroy S, et al. Survey of unlicenced and off-label drug use in
pediatric wards in European countries. BMJ 2000; 320: 79-82

2. Church D. Newborns are prescribed drugs only tested in animals.
eBMJ, March 03, 1999, in response to: White C: Newborns prescribed drugs
only tested in animals. BMJ 1999; 318: 554

3. Oommen T. Mini guinea-pigs, eBMJ, March 03, 1999, in response to:
White C. Newborns prescribed drugs only tested in adults. BMJ 1999; 318:

4. Abraham J, et al. Rethinking transparency and accountability in
the UK. BMJ 1998; 318: 46-47

5. "The Licence to rip off the public". In, Amazing medicines the
drug companies don't want you to discover. University Medical Publishers,
Tempe, Arizona, 1993

6. Klein R. Markets, politicians and the NHS. BMJ 1999; 319: 1383-84

Competing interests: No competing interests

10 January 2000
Tom Oommen
Associate Professor in Pharmacology
Fr. Muller's Medical College, Mangalore, India