A recent court ruling -- which convicted a doctor for causing adverse reactions in a Parkinson’s disease patient after prescribing metoclopramide -- met with a strong backlash from the medical community. 

The Changwon District Court sentenced the doctor to 10 months in prison and two years of probation for administering Macperan (ingredient: metoclopramide) to a Parkinson's disease patient in his 80s, causing injuries, including generalized weakness, speech impairment, and worsening Parkinson's disease. 

The medical community noted that the ruling was problematic that a "transient side effect" from a single dose of metoclopramide was deemed an injury when there were no reimbursable alternatives to metoclopramide. Physicians also noted that metoclopramide was "not an absolute contraindication" for Parkinson's patients. 

The Seoul Medical Association said on Monday that the ruling was based on a misunderstanding of the drug's action, adverse reactions, duration of action, and elimination time. The recent court ruling should be corrected by the Supreme Court, the association said. 

The Seoul doctors’ group emphasized that metoclopramide preparations are unlikely to cause irreversible side effects with a small dose and a single administration. 

Even transient side effects should resolve in up to 24 hours. The dose of metoclopramide administered by the convicted doctor was 10 mg. 

The Seoul Medical Association argued that the court could not distinguish between “contraindication” and “precaution," adding that patients with Parkinson's disease and patients treated with antiparkinsonian drugs are advised to avoid metoclopramide. 

“Metoclopramide is not contraindicated in patients with Parkinson's disease. It is just a drug that is recommended to be avoided," the SMA said. “The use of a small dose as a one-time treatment for patients with very severe vomiting symptoms is a decision that can be made based on the professional judgment of the physician, weighing the benefits and harms." Therefore, the first and second trial rulings were wrongly decided by judges who misunderstood the nature of the drug’s side effects and should be immediately corrected, the association argued, adding that transient side effects cannot be considered “serious harm.”

Barun Medicine Institute, a group of doctors seeking to correct misinformation about medicine and healthcare, released a statement on Monday, saying metoclopramide is the only antiemetics that healthcare providers can prescribe to patients with vomiting and nausea. There are dopamine receptor antagonists (metoclopramide) and serotonin antagonists, but "if the condition does not fall under the general indication for serotonin antagonists, which is vomiting after chemotherapy and surgery, it is illegal to administer the drug, even if the patient is willing to pay the full cost of the drug."

"If a patient comes to a rural clinic with nausea and vomiting, rather than a big city, as in this case, the only treatment available to the doctor is metoclopramide injection," Barun Medicine Institute said. "Even if the patient has a Parkinson's disease and if the doctor determines that it is necessary to relieve the symptoms quickly, there is nothing wrong with short-term use of metoclopramide, so the use of metoclopramide injection should be considered medically justified."

It should not be overlooked that medical testimony is subject to change depending on how the question is asked, the doctors’ group said. If the judge asks, "Is a single injection of metoclopramide likely to worsen the symptoms of a patient with Parkinson's disease," the expert's answer can only be "likely to worsen". However, if asked, "Is it more likely than not that the patient's symptoms were caused by a single injection of metoclopramide," the answer would be "not probabilistically likely.

"The expert opinion stated that short-term use of metoclopramide could be considered in situations where it is essential to control vomiting in patients with Parkinson's disease, but this was not taken into account by the court," Barun Medicine Institute said.

The medical decisions that have caused great social repercussions and resulted in many adverse effects have one thing in common: they were made in a biased manner, without recognizing or ignoring medical specificity and expertise, the institute went on to say. “The court should review the case again,” it said.