Doctor in child drug treatment row to face GMC

A DOCTOR who used controversial drug treatments on a hyperactive Scots child could be struck off after being accused of putting patients’ health at risk.

Dr Patrick Cosgrove, a leading advocate of medication to curb hyperactive behaviour, is due to appear before the General Medical Council tomorrow accused of serious professional misconduct.

The case is thought to be the first of its kind in the UK and could have important implications both for the treatment of children with Attention Deficit Hyperactivity Disorder (ADHD) and for the use of drugs on patients below the age for which they are licensed.

Cosgrove, a consultant child and adolescent psychiatrist who runs a private clinic in Bath, faces five allegations surrounding his practice. His name could be removed from the medical register if the GMC, which deals with complaints against doctors in the UK, finds against him.

The GMC said he was accused of "acting irresponsibly" in his monitoring of two patients receiving treatment for ADHD.

It is also claimed he failed to provide appropriate advice regarding a patient’s treatment to his GP, failed to conduct an appropriate examination of a patient and failed, in response to a request by a mental health NHS trust, to release a patient’s medical records.

In addition, it is alleged that on a number of occasions he made "unprofessional and unsustainable statements" about other doctors involved in the treatment of his patients which were "likely to cast doubt on their knowledge and skills".

One parent due to give evidence at the hearing in Manchester is Liz Thompson from Glasgow, who said her son Anthony was one of Cosgrove’s patients for three years from the age of 10. Anthony had behavioural problems from the age of four but a succession of doctors in Scotland failed to find either a final diagnosis or an effective treatment.

Thompson said she later realised his symptoms appeared to match those of ADHD, which makes children constantly fidgety, easily distracted and impulsive, as well as abusive and sometimes violent.

A support group then put her in touch with Cosgrove, who was already well-known for treating ADHD patients and has previously stated that he believes falling crime rates are the result of tackling the condition with drugs.

Thompson claimed Cosgrove diagnosed ADHD within 25 minutes, without speaking to or examining her son, and immediately gave her a prescription for Ritalin, a stimulant now in common use to treat the condition. She said once her son started taking the drug he stopped eating and sleeping properly, so she contacted Cosgrove again.

She claimed he prescribed a second drug, Risperidone, which is used to treat schizophrenia. Anthony took both drugs for three years, during which he was initially less disruptive but Thompson claimed he appeared to be "doped up".

When his behaviour began to deteriorate again, she sought help from the Overload Network, an Edinburgh-based charity which campaigns on behalf of ADHD sufferers and their parents.

The organisation recommended Thompson received a second opinion and a psychiatrist in Glasgow weaned her son off both drugs.

Overload then complained to the GMC about Cosgrove in relation both to Thompson and another parent of a hyperactive child he treated. More than three years after the first complaints, the GMC eventually decided to convene tomorrow’s hearing. Thompson said: "When I first went to see Dr Cosgrove I thought he was a godsend - the answer to all my prayers.

"I asked if Anthony still needed help along with the drugs and he said he would not need any whatsoever, that these drugs would take away any of the problems he had been experiencing. Nothing could be further from the truth."

She claimed Cosgrove never recommended that Anthony had tests to check how his body was dealing with the medication. Now 17, her son still has psychological problems, which she believes were masked but not treated by the drugs.

Janice Hill, of Overload, said she hoped the case would highlight the need to curb drug treatment for children with psychological problems.

Overload claims doctors write out prescriptions for Ritalin and other drugs far too readily, without trying alternative treatments such as altering diet or behavioural therapy.

US drug company Janssen, which markets Risperidone under the name Risperdal, says it is indicated for use only in schizophrenia and manic depression.

It is thought an adverse judgment against Cosgrove could make it more difficult for psychiatrists to prescribe such drugs "off-label" in the future.

FOR ADULTS ONLY?

MANY UK doctors routinely give patients under the age of 18 medicines that have been approved only for adults.

Seven out of 10 children prescribed a drug in the UK are given a substance that has not been officially approved for them, including psychiatric medicines, hormones, painkillers, sedatives and asthma treatments.

Growing concern about the issue could see pharmaceutical companies forced by the European Union to carry out clinical trials to check that all medicines given to children are suitable for them. New legislation could be introduced within two years.

The Department of Health said that in hospital intensive-therapy units up to 90% of children are given a drug which is either not licensed for them or is supposed to be used in a different dose or form or given only to older children.

In normal hospital units the figure is between 36% and 67% of children. Even in GPs’ surgeries it is estimated at between 22% and 56%.

The situation has arisen because very few drugs have been through clinical trials involving children.

On top of the difficulty of getting permission to test on children, drug companies have little incentive to get involved because children generally offer only a small market for a medicine.