A GP who became one of Britain's first doctors to offer consultations over the internet was this week accused at a GMC hearing of irresponsible prescribing.
Julian Eden, of St John's Wood, London, was interviewed by the BBC in 2000 as “the first doctor in the UK to offer both a diagnosis and prescriptions to patients over the internet.” He is the founder and medical director of e-med (http://e-med.co.uk), a website offering private medical services online.
But Dafydd Enoch, counsel for the GMC, said the service put patients at risk. “In this case you will hear that Dr Eden was consulted by highly vulnerable patients,” he told the hearing. “The striking similarity is the complete lack of any appropriate questions and the lack of any face to face consultation.”
“While his pockets were being lined, the patients were being drawn into dependency and abuse,” added Mr Enoch.
The accusations against Dr Eden relate to three patients and two journalists posing as patients who obtained drugs from various websites offering Dr Eden's services. The e-med service charged a £20 (€30; $39) annual membership fee and £15 for each online consultation.
Fiona Hutson, a mother of three from Edinburgh, told the hearing that she obtained diazepam and dihydrocodeine from Dr Eden for a year without ever meeting him for a face to face consultation.
She had been “devious” in finding ways to increase her intake, she said, by claiming that she was going on holiday or was under extra stress, thus getting her prescriptions refilled before they were due. She told the hearing: “I don't recall having an email back saying ‘Mrs Hutson this is too early, I think you are taking too much too soon.'”
She became increasingly dependent on the drugs and eventually took to paying for them with postal orders to hide her consumption from her family, she said.
Another patient, a Swansea businessman named only as Patient X, was prescribed a month's supply of the sleeping pills zolpidem 43 times and zopiclone eight times over a period of 26 months.
Mr Enoch said that Patient X obtained extra prescriptions from Dr Eden by claiming to have lost his script on “about a dozen” occasions. Dr Eden admits failing to verify that the prescriptions claimed as lost were never filled. Patient X later took to forging Dr Eden's prescription forms, until he was caught by police.
Patient A, a teenager, emailed the e-med website in 2004 claiming panic attacks and asking for benzodiazepines. Dr Eden refused to prescribe benzodiazepines without a face to face consultation but did offer to prescribe propranolol for anxiety if the patient joined e-med. He did not ask the patient's age, which was then 16.
While registering for the service Patient A indicated his age and revealed that he had a history of self harm and allergy and was being treated by child mental health services. In a further email he noted that he smoked cannabis regularly. Dr Eden prescribed propranolol but asked no further questions about the patient's history and did not suggest that he speak to his GP.
After a further email in which the patient mentioned suicidal thoughts Dr Eden suggested a personal consultation and began refusing further requests for drugs. But he relented when the patient asked for a renewal of his propranolol prescription. Six days later the patient took a non-lethal overdose of the drug.
Dr Eden also provided drugs without adequate consultation to two journalists posing as patients, the GMC alleged. Oliver Harvey of the Sun newspaper applied for the weight loss drug sibutramine (Reductil), giving his weight as 68 kg, but was refused as his body mass index was too low. He reapplied giving the same name but recording his weight as 114 kg and was given a month's supply, with no examination, blood pressure test, or advice on side effects.
Severin Carrell, of the Independent newspaper, received a prescription for sildenafil (Viagra) from Dr Eden within two minutes of applying on the website http://uk-clinic.co.uk.
Dr Eden admits all the factual allegations in the case. He admits inappropriate conduct in four of the five cases and irresponsible conduct in three. In the cases of Mrs Hutson and Patient X he admits that his conduct was not in the patient's best interest. The hearing is expected to last until February 23.