GP and their license

[jillc39]

when I was begging for more frequent injections my gp said if she gave me a B12 injection under four weeks she could loose her license. Is this true?... anyone else come up against this? It stopped me in my tracks.

[pugdogs10]

I am on 4 weekly injections. When I asked for more frequent injections to address my neuro symptoms he told me that he could not do this without the permission of a haematologist. The haemo then put me on weekly injections for a 10 week trial period.

I have never heard of " losing ones licence". It sounds like a cop out but could be true I suppose.

[Secondchance]

I get monthly injections prescribed. I heard one GP was investigated by General Medical Council for his prescription of B12 for patients so your GP maybe knows about that. Others here may know more.

[Twench]

Sounds like she is referring to Dr Chandy. He didn't lose his licence exactly but he did come under scrutiny for treating 'too many' patients with B12. I think he was forbidden from prescribing B12 for a period of time but I might be wrong.

Doctors certainly fear the auditors (whoever they are?) but there does not seem to be much public scrutiny of their activities.

[LtAngua52 in reply to Twench]

Dr Chandy was told to stop prescribing several times which caused the return of symptoms for many of his patient's so he prescribed again. Eventually he was forced to retire. He still wants to help people with low b12 which is why he set up his charity. If it wasn't for him so many of us would continue to suffer.

His example is used as a warning to other doctors who prescribe too frequently or outside the ranges. They are scared to lose their jobs like him

[jillc39]

what is his charity?

[Foggyme Administrator in reply to jillc39]

Hi jillc39. A question I can answer! His charity is b12d.org. X

[jillc39 in reply to Foggyme]

thanks foggyme - I have followed this up

[Hoxo in reply to jillc39]

B12d.org. He is a lovely person and excellent Doctor. He is helping our family. We have 6 family members affected by B12 deficiency. 3 have had B12 loading injections from own GPs as levels were below reference ranges but no top ups offered as anti intrinsic factor negative in all of us and no increase in MCV and so are self injecting, others are just self injecting as and when, as levels are just above reference ranges. We've given up asking our GPs to follow B12 deficiency treatment guidelines as they just don't seem to get it and are just self treating.

[clivealive Forum Support]

Hi jillc39 I came up against this "one size fits all" and you must "do what it says on the tin" syndrome 6 years ago. By then I'd been on four weekly injections of cyanocobalamin since 1972 just occasionally dropping in a three week appointment down through the years. Daft like I made the mistake of saying to my nurse on one occasion "see you in three weeks". She kindly "reported" me to my doctor who said it had to be four weeks between injections.

I then joined the PAS, found I was not the only person in the world to need more frequent injections, went back to my doctor armed with lots of information and he agreed to let me have an occasional three weekly injection "when I feel the need". My prescription was changed from "...every four weeks" to "use as directed".

[Gambit62 Administrator]

Unfortunately there are 2 angles:

a) injectable B12 is only licenced in the UK to be used with a frequency of every 2 months

b) as with the case of Dr Chandy there are instances where doctors have been seriously sanctioned for prescribing B12 more frequently.

Note: Dr Chandy's situation was complicated by some non-standard treatments around adrenal deficiency and I believe this is what was finally used to cause him to stop rather than just prescribing B12. I most certainly would not be seen as defending the establishment that hounded him as I believe he is a caring a far-sighted physician and what is actually needed is more physicians of his calibre.

At the end of the day doctors need to exercise clinical judgement but unfortunately doing that can be made very difficult where established rules and guidelines are actually the problem and the establishment is slow at best, and reluctant or even unwilling to review at worst.

[helvella in reply to Gambit62]

Hmmm, seems a bit less than cast in stone. Would it help to suggest you might suffer from Tobacco amblyopia or Leber's optic atrophy?

Tobacco amblyopia and Leber's optic atrophy:

Initially:

1000 micrograms daily by intramuscular injection for two weeks then twice weekly as long as improvement is maintained.

Maintenance:

1000 micrograms every three months or as required.

medicines.org.uk/emc/medici...

Tobacco amblyopia and Leber's optic atrophy

Initially, 1mg daily for 2 weeks, then 1mg twice weekly until no further improvement

Maintenance: 1mg every one to three months

medicines.org.uk/emc/medici...

Tobacco amblyopia and Leber's optic atrophy

Initially:1000 micrograms daily by intramuscular injection for two weeks then twice weekly as long as improvement is occurring.

Maintenance: 1000 micrograms every one to three months as required.

medicines.org.uk/emc/medici...

If it can be used for one thing every month, seems madness for it not to be allowed for another thing. Aside, of course, from the fact that doctors are supposed to do very frequent loading injections.

[Frodo]

It might be the case in your region - it seems like each health authority has different rules or procedures. I asked my GP if it was likely to be an issue early on but they didn't think so, and said it was up to them how many injections they prescribed.

I think perhaps it's a question of numbers. I think from what I've read that Dr Chandy realised, rightly, that a lot of people were suffering from B12 deficiency, and got better with treatment. And it was the numbers of people he treated that got him negative attention from those in charge. Despite the fact that those people were getting better and the treatment is inexpensive. Additionally, it seems likely that B12 can help people with other conditions as well, for which it wouldn't be licensed?

[fbirder]

Some doctors will give you the impression that any off-label prescribing will get them hung from the highest yardarm. In fact they all do it a lot. Here's what the UK government says about it - gov.uk/drug-safety-update/o... - here's a snippet...

However, there are clinical situations when the use of unlicensed medicines or use of medicines outside the terms of the licence (ie, ‘off-label’) may be judged by the prescriber to be in the best interest of the patient on the basis of available evidence. Such practice is particularly common in certain areas of medicine:

[sweetnessandlight]

How is it that the BNF protocol for b12d with neurological symptoms is injections every other day until no further improvement? How does this square with an 8 weekly licence?

[fbirder in reply to sweetnessandlight]

The license isn't for 8 weekly. The protocols described in the BNF are...

______________________________________________________________

Indications and dose

For HYDROXOCOBALAMIN:

Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency

By intramuscular injection

Adult

1 mg every 2–3 months.

Pernicious anaemia and other macrocytic anaemias without neurological involvement

By intramuscular injection

Adult

Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 3 months.

Pernicious anaemia and other macrocytic anaemias with neurological involvement

By intramuscular injection

Adult

Initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months.

Tobacco amblyopia

By intramuscular injection

Adult

Initially 1 mg daily for 2 weeks, then 1 mg twice weekly until no further improvement, then 1 mg every 1–3 months.

Leber's optic atrophy

By intramuscular injection

Adult

Initially 1 mg daily for 2 weeks, then 1 mg twice weekly until no further improvement, then 1 mg every 1–3 months.

For Cyanokit®:

Poisoning with cyanides

By intravenous infusion

Child (body-weight 5 kg and above)

Initially 70 mg/kg (max. per dose 5 g), to be given over 15 minutes, then 70 mg/kg (max. per dose 5 g) if required, this second dose can be given over 15 minutes–2 hours depending on severity of poisoning and patient stability.

Adult

Initially 5 g, to be given over 15 minutes, then 5 g if required, this second dose can be given over 15 minutes–2 hours depending on severity of poisoning and patient stability.

______________________________________________________________________

Useage outwith those listed is classed as off-license.

[jillc39 in reply to sweetnessandlight]

yes yes this is something I would really like to understand

[sweetnessandlight]

I rest my case!