SUDAFED
TABLETS / SYRUP Pseudoephed ri ne HCI Decongestant
Indications: Relief of nasal congestion associated with allergic rhinitis, acute coryza, vasomotor rhinitis, acute and subacute sinusitis, acute otitis media, asthma, postnasal drip, acute eustachian salpingitis. It may also be used as an adjunct to antibiotics, antihistamines, analgesics and antitussives in the treatment oftheaboveconditions. Contraindications: Patients receiving or having received MAO inhibitors in the preceding 3 weeks; known hypersensitivity to pressor amines. Precautions: As pseudoephedrine is a sympathomimetic amine, it should be used with caution in hypertensive and diabetic patients, patients with latent or clinically recognized angle-closure glaucoma, coronary artery disease, congestive heart failure, prostatic hypertrophy, hyperthyroidism, urinary retention. Adverse Effects: As with other sympathomimetic amines, headache, dizziness, insomnia, tremor, confusion, CNS stimulation, muscular weakness, dry mouth, nausea, vomiting, difficulty in micturition, palpitations, tightness in thechest and syncopemaybeencountered. Overdose: Symptoms: Increase in pulse and respiratory rate, CNS stimulation, disorientation, headache, dry mouth, nausea and vomiting. Treatment: Gastric lavage, repeated if necessary. Acidify the urine and institute general supportive measures. If CNS excitement is prominent,a short-acting barbiturate may beused. Dosage: Adults and children over 6 years: 2 teaspoonfuls of syrup or 1 tablet 3 times daily. Children 4 months to 6 years: 1/2 adult dose. Infants upto4 months: 1/2 teaspoonful of syrup3 times daily. Supplied: Syrup: Each 5 ml of clear purplish-red syrup with a sweet raspberry flavor contains: pseudoephedrine HCI 30 mg. Available in 100 ml and 250 ml bottles. Tablets: Each white, biconvex tablet 8.6 mm in diameter with code number WELLCOMES7A on same side as diagonal score mark contains: pseudoephedrine HCI 60 mg. Available in cartonsof 18 and bottlesof lOOand SOOtablets. Additional prescribing information available on request.
Wellconie Medcai Division .jBurrou.hs Welicome Ltd. 0u6.
r.xii
Trade Mark .
W-8004
tion: coffee is preferred by heavy smokers because of its higher caffeine content as it is usually prepared in Ontario.2 For heavy cigarette smokers who continue to drink tea, taste or cost might be an especially important consideration. Alternatively, strong tea may be consumed, as it is in Britain, where the average caffeine content of tea is similar to that of coffee as usually prepared.3 Speculating on cause from correlation data is risky. My analysis suggests that cigarette smoking is a factor in the choice of beverage. It could be argued with equal validity that consumption of a beverage, particularly coffee, is a factor in cigarette smoking. Further research is clearly required if the relations between these two popular habits are to be unravelled. The assistance of Mr. Henzel Jupiter in the analysis of data is gratefully acknowledged. R.M. GILBERT, PH D
Addiction Research Foundation Toronto, Ont. References 1. GILBERT RM: Caffeine as a drug of abuse, in Research Advances in Alcohol and Drug Problems, vol 3, GIBBINS RJ, ISRAEL Y, KALANT H, et al
(eds), Wiley, New York, 1976, pp 49-176 2. GILBERT RM, MARSHMAN JA, SCHWIE-
DER M, et al: Caffeine content of beverages as consumed. Can Med
Assoc 1 114: 205, 1976 3. ALSAMARRAE W, MA MCF, TRUSWELL
AS: Methyixanthine consumption from coffee and tea. Proc Nutr Soc 34: A18, 1975
Role and training of paramedical groups To the editor: Paramedics have much to offer in the treatment of musculoskeletal problems, particularly backand neckaches. Physicians specializing in orthopedics, and physiatrists, are likely to remain scarce, possibly because of the lingering belief that nothing can be done or needs to be done in such cases. Thus, family physicians often become greatly experienced in the treatment of musculoskeletal problems, and with proper training this work becomes rewarding. The
524 CMA JOURNAL/MARCH 3, 1979/VOL. 120
orthopedic department at the University of Rochester Medical Center has been teaching management of musculoskeletal problems to residents in family and internal medicine for the past 3 years. It is one of the most popular special disciplinary electives. Success in this area depends on whether the physician finds him- or herself in a practice situation where a physiotherapist trained in orthopedics is available. The orthopedic division of the Canadian Physiotherapy Association, numerically strong in Ontario, has been giving exacting instruction courses and examinations for some years. While manipulation is one of the modalities used (bias against this method will no doubt linger for 1 or 2 more years), many primary care physicians and orthopedists have been delighted with the positive and effective roles of physiotherapists. It is a pleasure to discuss diagnosis and treatment with them on equal terms. RICHARD M. ELLIs, FRCS, MRCP
Department of orthopedics University of Rochester Medical Center Rochester, New York
How social health insurance should be financed To the editor: Drs. C. Kapsalis and P. Manga (Can Med Assoc J 119: 1335, 1978) may be knowledgeable about economics, but they know little about medical practice. Using income tax to pay for health services (perish the thought) is akin to asking a temperance society to pay for the rehabilitation of alcoholics. In my practice I treat persons at every socioeconomic level; by far the greatest users and abusers of medicare are those in the low socioeconomic groups. The people most likely to practise preventive health care measures are in the higher socioeconomic groups. Most of today's ill health is caused by a certain lifestyle and is not an act of God. Good health is a personal responsibility; how unfair can one be in asking persons who look after their health to pay for those who don't? J.D. BROwN, MB, B CH, BAO, DPH
Avon Medical Centre Regina, Sask.
TABLETS / SYRUP Pseudoephed ri ne HCI Decongestant
Indications: Relief of nasal congestion associated with allergic rhinitis, acute coryza, vasomotor rhinitis, acute and subacute sinusitis, acute otitis media, asthma, postnasal drip, acute eustachian salpingitis. It may also be used as an adjunct to antibiotics, antihistamines, analgesics and antitussives in the treatment oftheaboveconditions. Contraindications: Patients receiving or having received MAO inhibitors in the preceding 3 weeks; known hypersensitivity to pressor amines. Precautions: As pseudoephedrine is a sympathomimetic amine, it should be used with caution in hypertensive and diabetic patients, patients with latent or clinically recognized angle-closure glaucoma, coronary artery disease, congestive heart failure, prostatic hypertrophy, hyperthyroidism, urinary retention. Adverse Effects: As with other sympathomimetic amines, headache, dizziness, insomnia, tremor, confusion, CNS stimulation, muscular weakness, dry mouth, nausea, vomiting, difficulty in micturition, palpitations, tightness in thechest and syncopemaybeencountered. Overdose: Symptoms: Increase in pulse and respiratory rate, CNS stimulation, disorientation, headache, dry mouth, nausea and vomiting. Treatment: Gastric lavage, repeated if necessary. Acidify the urine and institute general supportive measures. If CNS excitement is prominent,a short-acting barbiturate may beused. Dosage: Adults and children over 6 years: 2 teaspoonfuls of syrup or 1 tablet 3 times daily. Children 4 months to 6 years: 1/2 adult dose. Infants upto4 months: 1/2 teaspoonful of syrup3 times daily. Supplied: Syrup: Each 5 ml of clear purplish-red syrup with a sweet raspberry flavor contains: pseudoephedrine HCI 30 mg. Available in 100 ml and 250 ml bottles. Tablets: Each white, biconvex tablet 8.6 mm in diameter with code number WELLCOMES7A on same side as diagonal score mark contains: pseudoephedrine HCI 60 mg. Available in cartonsof 18 and bottlesof lOOand SOOtablets. Additional prescribing information available on request.
Wellconie Medcai Division .jBurrou.hs Welicome Ltd. 0u6.
r.xii
Trade Mark .
W-8004
tion: coffee is preferred by heavy smokers because of its higher caffeine content as it is usually prepared in Ontario.2 For heavy cigarette smokers who continue to drink tea, taste or cost might be an especially important consideration. Alternatively, strong tea may be consumed, as it is in Britain, where the average caffeine content of tea is similar to that of coffee as usually prepared.3 Speculating on cause from correlation data is risky. My analysis suggests that cigarette smoking is a factor in the choice of beverage. It could be argued with equal validity that consumption of a beverage, particularly coffee, is a factor in cigarette smoking. Further research is clearly required if the relations between these two popular habits are to be unravelled. The assistance of Mr. Henzel Jupiter in the analysis of data is gratefully acknowledged. R.M. GILBERT, PH D
Addiction Research Foundation Toronto, Ont. References 1. GILBERT RM: Caffeine as a drug of abuse, in Research Advances in Alcohol and Drug Problems, vol 3, GIBBINS RJ, ISRAEL Y, KALANT H, et al
(eds), Wiley, New York, 1976, pp 49-176 2. GILBERT RM, MARSHMAN JA, SCHWIE-
DER M, et al: Caffeine content of beverages as consumed. Can Med
Assoc 1 114: 205, 1976 3. ALSAMARRAE W, MA MCF, TRUSWELL
AS: Methyixanthine consumption from coffee and tea. Proc Nutr Soc 34: A18, 1975
Role and training of paramedical groups To the editor: Paramedics have much to offer in the treatment of musculoskeletal problems, particularly backand neckaches. Physicians specializing in orthopedics, and physiatrists, are likely to remain scarce, possibly because of the lingering belief that nothing can be done or needs to be done in such cases. Thus, family physicians often become greatly experienced in the treatment of musculoskeletal problems, and with proper training this work becomes rewarding. The
524 CMA JOURNAL/MARCH 3, 1979/VOL. 120
orthopedic department at the University of Rochester Medical Center has been teaching management of musculoskeletal problems to residents in family and internal medicine for the past 3 years. It is one of the most popular special disciplinary electives. Success in this area depends on whether the physician finds him- or herself in a practice situation where a physiotherapist trained in orthopedics is available. The orthopedic division of the Canadian Physiotherapy Association, numerically strong in Ontario, has been giving exacting instruction courses and examinations for some years. While manipulation is one of the modalities used (bias against this method will no doubt linger for 1 or 2 more years), many primary care physicians and orthopedists have been delighted with the positive and effective roles of physiotherapists. It is a pleasure to discuss diagnosis and treatment with them on equal terms. RICHARD M. ELLIs, FRCS, MRCP
Department of orthopedics University of Rochester Medical Center Rochester, New York
How social health insurance should be financed To the editor: Drs. C. Kapsalis and P. Manga (Can Med Assoc J 119: 1335, 1978) may be knowledgeable about economics, but they know little about medical practice. Using income tax to pay for health services (perish the thought) is akin to asking a temperance society to pay for the rehabilitation of alcoholics. In my practice I treat persons at every socioeconomic level; by far the greatest users and abusers of medicare are those in the low socioeconomic groups. The people most likely to practise preventive health care measures are in the higher socioeconomic groups. Most of today's ill health is caused by a certain lifestyle and is not an act of God. Good health is a personal responsibility; how unfair can one be in asking persons who look after their health to pay for those who don't? J.D. BROwN, MB, B CH, BAO, DPH
Avon Medical Centre Regina, Sask.
