les complications m.dicales augmenteront . mesure que cette technique prendra de l'ampleur et sera offerte . un plus grand nombre de patientes. Si l'on s'en tient . l'.ge maternel avanc. et aux malformations du tube neural, cet examen pourrait tbeoriquement s'appliquer . pr.s de 10 000 patientes par annie au pays, soit 10 fois plus qu'actuellement. Heureusement, 1'attitude
conservatrice du m.decin et du public face au diagnostic pr.nata1 permettra tine meilleure planification des services et des besoins techniques. Cet investissement se justifierait par Ia diminution de syndromes majeurs qui ont parfois des effets destructeurs sur la vie familiale et le moral des parents. D'autres .tapes seront franchies dans Ia prevention et le traitement des ma-
ladies cong.nita1es, Si Ufl lien etroit persiste entre les aspects de recherche et de service du diagnostic prenatal. Louis DALLAIRE, MD
Section de genetique m.dicale H6pital Sainte-Justine Montr.aI, PQ
Bibliographie 1. Canadian guidelines for antenatal diagnosis of genetic disease: a joint statement. Can Med Assoc 1 111: 180, 1974
Scientific and medical journals: obsolete or overgrown? A characteristic of scientific literature, of which medical journals form a part, is the continuing increase in volume, such that the world literature doubles in volume approximately every 15 years.1 Such an increase amounts to almost a natural phenomenon, for it has been true of the development of science ever since the first scientific journal, Philosophical Transactions, was introduced over 300 years ago. The number of scientific journals now in existence is impossible to count, and it is perhaps irrelevant, for it is the complexity of the problem that is important rather than the magnitude (of the order of 3000 to 10000 journals). According to one estimate made a decade ago, a 3000-character/mm reader of journals in 1906 would have required only 25 min/d to keep abreast of scientific advances in his field, whereas in 1977 he would have to read continuously every hour of every day to do SO.2 This situation will continue to become more acute. Readers of scientific journals who want to rely on journals to keep up to date with advances in knowledge are, therefore, faced with an impossible task. No wonder some believe that the scientific literature system is obsolete. This view, that the present formal system of scientific communication is obsolete, was the subject of a debate recently cosponsored by the American Institute of Biological Sciences, the BioSciences Information Service of Biological Abstracts and the Council of Biology Editors. The debate was inconclusive; neither the proponents nor the opponents could claim victory. The debate, however, was less negative than one might suppose: the message transmitted by the four panelists was that the formal scientific paper is "not a dead duck but a pregnant one" and that technologic methods of publication and information transfer are available to us in trying to solve the problems of an ever-burgeoning literature. We are, however, creatures of convention and tradition and we institute changes only
when we are forced to do so, sometimes years after the means have first been available. The geometric increase in the volume of scientific literature is but one half of the problem of extracting relevant information from the literature. The other half is the variation in the quality of what is published. This concern, like that of the volume, is nothing new: nearly a century ago John Shaw Billings, the first director of the US National Library of Medicine, said of the medical literature that "nine-tenths at least, of it, becomes worthless, and of no interest within ten years after the date of its publication, and much of it is so when it first appears".3 Similar pronouncements have been made on many occasions since, and one is forced to conclude that scientific journals always have contained and always will contain too much that is too poor in quality. That the literature contains an excess of what, in Billings' words, is "effete and worthless"4 is indeed a strong condemnation of the scientific literature system. Yet the scientific journal, as the exemplar of the scientific literature system, survives; it certainly is not dead, and if it is a pregnant duck, then this duck is continuously enlarging. The scientific journal survives because its advantages and strengths outweigh its disadvantages and weaknesses, and because none of the many alternatives to the scientific journal is superior. Certainly there has been no lack of suggestions for such alternatives to the traditional journal.57 Consider them: repackaging of journals of broad interest and scope into smaller units of coverage of relatively greater interest to smaller groups of readers; dissemination of copies of unpublished papers and reprints of published papers either on request or on a user-profile basis; greater use of extended abstracts, synopses or other surrogates; institution of "announcement" journals backed up by availability of full papers in central
714 CMA JOURNAL/OCTOBER 23, 1976/VOL. 115
depositories; restrictions of journal content to short papers or letters; creation of central clearing-houses for collection and distribution of papers, so that papers rather than journals will be the primary sources of information; storage and primary distribution of material in microfilm or microfiche format; distribution of preprints; greater use of reports and newsletters; and wider use of photocopied material based on presentations at conferences and symposia. This is an impressive catalogue of alternatives and many of them have much merit - but the fact remains that scientific and medical journals have survived because they are functionally useful. Scientific journals have survived because they have an important role in scientific communication and in the "behaviour" of scientific disciplines. Despite problems such as delay in publication (often imposed by the processes of manuscript review and editorial decision-making that quality control requires), attention to detail, complexity of printing and publishing and, especially, cost, scientific journals offer noteworthy advantages that make them superior to any of the alternatives. The reviewing system provides control over both quality and quantity of publication; editorial decision-making attempts to provide journal readers with something of interest; a consistent and formal structure that is well organized makes for effective communication the reader can find his way around a familiar journal; their very presence, tangibility and permanence suit journals to their readers' different needs; the regularity and continuity of journals serve the requirements of coherence and vitality in various disciplines, professions and societies; and their browsing potential often leads to a crossfertilization of ideas that must not be underrated. Scientific journals serve the needs of communication of current information and of archival storage of information acceptably, but there is an-
other function of journals, a social one: scientific communication is more personal and more subjective than we sometimes realize - there is "a degree of resonance"8 between author and reader that is absent from the somewhat impersonal alternatives to the scientific journal. In short, the scientific journal becomes a part of many scientists' lives. What are the implications of these considerations for this journal? Four are particularly important. First, there must be "a degree of resonance" between the Journal and its readers and authors; the Journal must serve the varying needs of its readers and of the Canadian Medical Association. Second, what is p1.esented must ideally be of excellent quality, both of content and style. Third, because the size of the Journal is limited for financial reasons, each contribution must be short, so that not only will the busy physicianreader be able to read it in the time he has available, but also a greater and fairer proportion of material submitted will be publishable, provided quality is acceptable (more manuscripts can be published if brevity is a major criterion). And fourth, to move with the times, the Journal must make use of technologic advances that become available to the publishing and printing industry. Considerations such as these are always under editorial review, but the type of papers published and their quality and length should, in view of the many determinants that mould an association journal, be pondered by readers as well. A former editorialist implied that the relation between an editor and the readers of a journal resembles that between a member of Parliament and his representatives.9 He quoted Edmund Burke,1 who spoke of the need for a parliamentarian to foster "the most unreserved communication with his constituents" and who recognized that "their wishes ought to have great weight with him [and] their opinion high respect". At the same time, however, Burke was convinced that "his unbiased opinion, his mature judgement, his enlightened conscience, he ought not to sacrifice.., to any man or to any set of men living". In other words, the need for communication of ideas and opinions, as so often is the case in social activity, is paramount: editors need to know the views and wishes of readers, and readers need the opinions and judgement of editors; but the need is for two-way communication. If this is achieved, the Canadian Medical Association Journal will continue to thrive, despite the belief of some that the scientific literature system is obsolete. DAVID A. E. SHEPHARD
References 1. CUMMINGS MM: Publications: progress or poliution? Am Sci 61: 163, 1973 2. LIcKLIDER JCR: A crux in scientific and technical communication. Am Psychol 21: 1044, 1966 3. BILLINGS JS: Methods of research in medical literature. Trans Assoc Am Physicians 2: 57, 1887 4. Idem: On medical literature, in Transactions of the Seventh International Medical Congress, vol 1, London, Kolckmann, 1881, p 54 5. PHELPS RH, HERLIN JP: Alternatives to the scientific periodical: a report and bibliography. Unesco Bull Libr 14: 61, 1960 6. LANCASTER
7. 8. 9. 10.
FW,
BROWN
AM:
Conceptual
Alternatives to the Scientific Journal, American Geological Institute, Bethesda, 1969 HERSCHMAN A: The primary journal: past, present, and future. I Chem Doc 10: 37, 1970 ORR RH: Communication problems in biochemical research: report of a study. Fed Proc 23: 1117, 1964 Medical journalism. VI: the independence of journals (E). Can Med Assoc 1 92: 932, 1965 BURKE E: Speech to the electors of Bristol, Nov 3, 1774, in The Writings and Speeches of Edmund Burke, vol 2, Boston, Little, 1901, p 95
BOOKS This list is an acknowledgement of books received. It does not preclude review at a later date. ADVANCES IN PEDIATRICS. Vol. 22. Edited by Irving Schulman. 409 pp. Year Book Medical Publishers. Inc.. Chicago. 1976 ALLERGY AND CLINICAL IMMUNOLOGY. L.I. Criep. 641 pp. Grune & Stratton, Inc., New York; Longman Canada Limited, Toronto. 1976. $51.75 BASIC PATHOLOGY. 2nd ed. Stanley 1. Robbins and Marcia Angell. 705 pp. lIlust. W.B. Saunders Company. Philadelphia; W.B. Saunders Company Canada Limited. Toronto. 1976. $19.05 CLINICAL EXAMINATIONS IN NEUROLOGY. 4th ed. JE. Thomas and A.J.D. Dale. 385 pp. Illust. W.B. Saunders Company. Philadelphia; W.B. Saunders Company Canada Limited, Toronto. 1976 COLOR ATLAS AND TEXTBOOK OF PATHOLOGY. 2nd ed. W. Sandritter Thomes. Translated by W.H. Kirsten. Schaltauer Verlag. Stuttgart; Year Book Publishers. Inc.. Chicago. 1976
MACRO. and C. 361 pp. Medical
COLOR ATLAS OF GENERAL SURGICAL DIAG. NOSIS. W.F. Walker. 448 pp. Wolfe Medical Publishers, London; Year Book Medical Publishers, Inc., Chicago. 1976 COMPARATIVE LEUKEMIA RESEARCH. J. Clemmesen and D.S. Yohn. 592 pp. Illust. S. Karger Medical and Scientific Publishers, Basel, 1976. $82 COWDRY'S - THE CARE OF THE GERIATRIC PATIENT. F.U. Steinberg. 518 PP. The CV. Mosby Company. St. Louis. 1976. $31 DEVELOPMENT OF VACCINES FOR FERTILITY REGULATION. Papers presented at the WHO-sponsored Session of the Third International Symposium on Immunology of Reproduction, Varna. Bul.aria. Sept. 1975. 142 pp. lIlust. WHO and cri Ptor. Copenhagen. 1976 DISORDERS OF THE GASTROINTESTINAL TRACT: DISORDERS OF THE LIVER: NUTRITIONAL DIS. ORDERS. J.M. Dietschy. 418 pp. Illust. Grune & Stratton, Inc.. New York; Longman Canada Limited. Toronto, 1976. $28.25 DRUG LAG. FEDERAL GOVERNMENT DECISION MAKING. Edited by Rita Ricardo Campbell. 62 pp. Hoover Institution Press, Stanford, 1976 EXAMINATION IN MEDICINE. P.R. Fleming, PH. Sanderson, J.F. Stokes and H.J. Walton, 115 pp. Churchill Livingstone. Edinburgh; Longman Canada Limited, Toronto, 1976. $4.25
IndIcations and Clinical Ussa: Ibuprofen is indicated for the treatment of osteoarthritis and rheumatoid arthritia. Contraindicatlons: Ibuprofen should not be uaed during pregnancy or in pmdiatric patienta becauae ita aafety under theae conditiona haa not been eatablished. Ibuprofen should not be used in patienta with a hiatory of acetylsalicylic acidinduced bronchospasm. Precautions: Ibuprofen ahould be used with caution in patienta with a hiatory of gastrointeatinal ulceration. Ibuprofen haa been reported to be aaaociated with toxic amblyopia. Therefore precautiona ahould be taken to enaure that patienta on ibuprofen therapy report to their phyaiciana for full ophthalmological examination if they experience any viaual difficulty. Medication ahould be diacontinued if there ia any evidence of toxic amblyopia. Adverse ReactIons: The following adverae reactiona have been noted in patienta treated with ibuprofen. Gesfroinfesfinal: Nauaea, vomiting, diarrhraa, conatipation, dyapepaia, epigaatric pain and guaiac poaitive stools have been noted. A few caaea of gaatric or duodenal ulceration, Including aome complicated by bleeding or perforation have occurred. Cenfral Nervous Sysfem: Dizzineaa, light-head.. edneaa, headache, anxiety, mental confuaion and depreaaion were noted in aome patienta treated with ibuprofen. Ophfhalmologlcal: Blurred viaion waa noted In aome patienta and rarely a aenaation of moving lighta waa obaerved following adminiatration of ibuprofen. In addition there are three publiahed caaea of toxic amblyopia asaociated with the uae of ibuprofen. Although a definite cauae and effect relationahip waa not eatablished, the attending phyalciana conaidered them to be drug related. The condition waa characterized by reduced viaual acuity and difficulty in colour diacrimination. Defecta (uaually centroctacal) were obaerved on viaual field examination. Symptoma were reveraible on diacontinuatlon of treatment. Skin: Maculopapular rashes, urticaria, and generalized pruritua have been reported with ibuproten therapy. Occaaional cases of radema have also been reported. Laborafory Teafa: Sporadic abnormalitiea of liver function teata have occurred in patienta on ibuprofen therapy (SGOT, aerum bilirubin and alkaline phosphataae) but no definite trend waa aeen indicating toxicity. Similar abnormalitiea of white blood count and blood urea determinationa were noted. A alight fall in hwmoglobin and hmmatocrit haa been noted in aome patienta. Symptoms and Treatment of Overdosag.: One caae of overdoaage haa been reported. A oneyear-old child ingeated 1200 mg ibuprofen and auffered no ill effecta other than being droway the next day. Blood levels of ibuprofen reached 711 mcg/ml, which Is conaiderably above the 90 mcg/ml previously recorded aa the higheat level aeen in adults after a aingle oral doae of 800 mg. The SGPT level, nine daya poat-ingestion, waa 72. No apecific antidote ia known. Standard meaaurea to atop further abaorption and maintain urine output ahould be Implemented at once. The drug ia excreted rapidly and excretion Is almoat complete In aix houra. Dosage and AdmInIstratIon: To obtain rapid reaponae at the atart of treatment, particularly when tranaferring from other anti-inflammatory therapy, Motrin ahould be given at a dose of 1200 mg per day in 4 divided doses. Depending on the therapeutic reaponae, the doae may be adjuated downward or upward keeping the 4 timea a day dos.g&achedule. The daily doae ahould not exceed 2400 mg. Maintenance therapy, once maximum reaponae ia obtained, will range from 800 to 1200 mg per day. Due to lack of clinical experience, ibuprofen ia not indicatbd for uae in children under 12 yeara of age. SupplIed: 200 mg yellow coated tableta and 300 mg white coated tablets in bottlea of 100 and 1000. 765
REGISTERED TRAOEMARK. MOTRIN
-
CER37R.5
THE UPJOHN COMPANY OF CANADA DON MILLS, ONTARIO
continued on page 782 CMA JOURNAL/OCTOBER 23, 1976/VOL. 115 715
conservatrice du m.decin et du public face au diagnostic pr.nata1 permettra tine meilleure planification des services et des besoins techniques. Cet investissement se justifierait par Ia diminution de syndromes majeurs qui ont parfois des effets destructeurs sur la vie familiale et le moral des parents. D'autres .tapes seront franchies dans Ia prevention et le traitement des ma-
ladies cong.nita1es, Si Ufl lien etroit persiste entre les aspects de recherche et de service du diagnostic prenatal. Louis DALLAIRE, MD
Section de genetique m.dicale H6pital Sainte-Justine Montr.aI, PQ
Bibliographie 1. Canadian guidelines for antenatal diagnosis of genetic disease: a joint statement. Can Med Assoc 1 111: 180, 1974
Scientific and medical journals: obsolete or overgrown? A characteristic of scientific literature, of which medical journals form a part, is the continuing increase in volume, such that the world literature doubles in volume approximately every 15 years.1 Such an increase amounts to almost a natural phenomenon, for it has been true of the development of science ever since the first scientific journal, Philosophical Transactions, was introduced over 300 years ago. The number of scientific journals now in existence is impossible to count, and it is perhaps irrelevant, for it is the complexity of the problem that is important rather than the magnitude (of the order of 3000 to 10000 journals). According to one estimate made a decade ago, a 3000-character/mm reader of journals in 1906 would have required only 25 min/d to keep abreast of scientific advances in his field, whereas in 1977 he would have to read continuously every hour of every day to do SO.2 This situation will continue to become more acute. Readers of scientific journals who want to rely on journals to keep up to date with advances in knowledge are, therefore, faced with an impossible task. No wonder some believe that the scientific literature system is obsolete. This view, that the present formal system of scientific communication is obsolete, was the subject of a debate recently cosponsored by the American Institute of Biological Sciences, the BioSciences Information Service of Biological Abstracts and the Council of Biology Editors. The debate was inconclusive; neither the proponents nor the opponents could claim victory. The debate, however, was less negative than one might suppose: the message transmitted by the four panelists was that the formal scientific paper is "not a dead duck but a pregnant one" and that technologic methods of publication and information transfer are available to us in trying to solve the problems of an ever-burgeoning literature. We are, however, creatures of convention and tradition and we institute changes only
when we are forced to do so, sometimes years after the means have first been available. The geometric increase in the volume of scientific literature is but one half of the problem of extracting relevant information from the literature. The other half is the variation in the quality of what is published. This concern, like that of the volume, is nothing new: nearly a century ago John Shaw Billings, the first director of the US National Library of Medicine, said of the medical literature that "nine-tenths at least, of it, becomes worthless, and of no interest within ten years after the date of its publication, and much of it is so when it first appears".3 Similar pronouncements have been made on many occasions since, and one is forced to conclude that scientific journals always have contained and always will contain too much that is too poor in quality. That the literature contains an excess of what, in Billings' words, is "effete and worthless"4 is indeed a strong condemnation of the scientific literature system. Yet the scientific journal, as the exemplar of the scientific literature system, survives; it certainly is not dead, and if it is a pregnant duck, then this duck is continuously enlarging. The scientific journal survives because its advantages and strengths outweigh its disadvantages and weaknesses, and because none of the many alternatives to the scientific journal is superior. Certainly there has been no lack of suggestions for such alternatives to the traditional journal.57 Consider them: repackaging of journals of broad interest and scope into smaller units of coverage of relatively greater interest to smaller groups of readers; dissemination of copies of unpublished papers and reprints of published papers either on request or on a user-profile basis; greater use of extended abstracts, synopses or other surrogates; institution of "announcement" journals backed up by availability of full papers in central
714 CMA JOURNAL/OCTOBER 23, 1976/VOL. 115
depositories; restrictions of journal content to short papers or letters; creation of central clearing-houses for collection and distribution of papers, so that papers rather than journals will be the primary sources of information; storage and primary distribution of material in microfilm or microfiche format; distribution of preprints; greater use of reports and newsletters; and wider use of photocopied material based on presentations at conferences and symposia. This is an impressive catalogue of alternatives and many of them have much merit - but the fact remains that scientific and medical journals have survived because they are functionally useful. Scientific journals have survived because they have an important role in scientific communication and in the "behaviour" of scientific disciplines. Despite problems such as delay in publication (often imposed by the processes of manuscript review and editorial decision-making that quality control requires), attention to detail, complexity of printing and publishing and, especially, cost, scientific journals offer noteworthy advantages that make them superior to any of the alternatives. The reviewing system provides control over both quality and quantity of publication; editorial decision-making attempts to provide journal readers with something of interest; a consistent and formal structure that is well organized makes for effective communication the reader can find his way around a familiar journal; their very presence, tangibility and permanence suit journals to their readers' different needs; the regularity and continuity of journals serve the requirements of coherence and vitality in various disciplines, professions and societies; and their browsing potential often leads to a crossfertilization of ideas that must not be underrated. Scientific journals serve the needs of communication of current information and of archival storage of information acceptably, but there is an-
other function of journals, a social one: scientific communication is more personal and more subjective than we sometimes realize - there is "a degree of resonance"8 between author and reader that is absent from the somewhat impersonal alternatives to the scientific journal. In short, the scientific journal becomes a part of many scientists' lives. What are the implications of these considerations for this journal? Four are particularly important. First, there must be "a degree of resonance" between the Journal and its readers and authors; the Journal must serve the varying needs of its readers and of the Canadian Medical Association. Second, what is p1.esented must ideally be of excellent quality, both of content and style. Third, because the size of the Journal is limited for financial reasons, each contribution must be short, so that not only will the busy physicianreader be able to read it in the time he has available, but also a greater and fairer proportion of material submitted will be publishable, provided quality is acceptable (more manuscripts can be published if brevity is a major criterion). And fourth, to move with the times, the Journal must make use of technologic advances that become available to the publishing and printing industry. Considerations such as these are always under editorial review, but the type of papers published and their quality and length should, in view of the many determinants that mould an association journal, be pondered by readers as well. A former editorialist implied that the relation between an editor and the readers of a journal resembles that between a member of Parliament and his representatives.9 He quoted Edmund Burke,1 who spoke of the need for a parliamentarian to foster "the most unreserved communication with his constituents" and who recognized that "their wishes ought to have great weight with him [and] their opinion high respect". At the same time, however, Burke was convinced that "his unbiased opinion, his mature judgement, his enlightened conscience, he ought not to sacrifice.., to any man or to any set of men living". In other words, the need for communication of ideas and opinions, as so often is the case in social activity, is paramount: editors need to know the views and wishes of readers, and readers need the opinions and judgement of editors; but the need is for two-way communication. If this is achieved, the Canadian Medical Association Journal will continue to thrive, despite the belief of some that the scientific literature system is obsolete. DAVID A. E. SHEPHARD
References 1. CUMMINGS MM: Publications: progress or poliution? Am Sci 61: 163, 1973 2. LIcKLIDER JCR: A crux in scientific and technical communication. Am Psychol 21: 1044, 1966 3. BILLINGS JS: Methods of research in medical literature. Trans Assoc Am Physicians 2: 57, 1887 4. Idem: On medical literature, in Transactions of the Seventh International Medical Congress, vol 1, London, Kolckmann, 1881, p 54 5. PHELPS RH, HERLIN JP: Alternatives to the scientific periodical: a report and bibliography. Unesco Bull Libr 14: 61, 1960 6. LANCASTER
7. 8. 9. 10.
FW,
BROWN
AM:
Conceptual
Alternatives to the Scientific Journal, American Geological Institute, Bethesda, 1969 HERSCHMAN A: The primary journal: past, present, and future. I Chem Doc 10: 37, 1970 ORR RH: Communication problems in biochemical research: report of a study. Fed Proc 23: 1117, 1964 Medical journalism. VI: the independence of journals (E). Can Med Assoc 1 92: 932, 1965 BURKE E: Speech to the electors of Bristol, Nov 3, 1774, in The Writings and Speeches of Edmund Burke, vol 2, Boston, Little, 1901, p 95
BOOKS This list is an acknowledgement of books received. It does not preclude review at a later date. ADVANCES IN PEDIATRICS. Vol. 22. Edited by Irving Schulman. 409 pp. Year Book Medical Publishers. Inc.. Chicago. 1976 ALLERGY AND CLINICAL IMMUNOLOGY. L.I. Criep. 641 pp. Grune & Stratton, Inc., New York; Longman Canada Limited, Toronto. 1976. $51.75 BASIC PATHOLOGY. 2nd ed. Stanley 1. Robbins and Marcia Angell. 705 pp. lIlust. W.B. Saunders Company. Philadelphia; W.B. Saunders Company Canada Limited. Toronto. 1976. $19.05 CLINICAL EXAMINATIONS IN NEUROLOGY. 4th ed. JE. Thomas and A.J.D. Dale. 385 pp. Illust. W.B. Saunders Company. Philadelphia; W.B. Saunders Company Canada Limited, Toronto. 1976 COLOR ATLAS AND TEXTBOOK OF PATHOLOGY. 2nd ed. W. Sandritter Thomes. Translated by W.H. Kirsten. Schaltauer Verlag. Stuttgart; Year Book Publishers. Inc.. Chicago. 1976
MACRO. and C. 361 pp. Medical
COLOR ATLAS OF GENERAL SURGICAL DIAG. NOSIS. W.F. Walker. 448 pp. Wolfe Medical Publishers, London; Year Book Medical Publishers, Inc., Chicago. 1976 COMPARATIVE LEUKEMIA RESEARCH. J. Clemmesen and D.S. Yohn. 592 pp. Illust. S. Karger Medical and Scientific Publishers, Basel, 1976. $82 COWDRY'S - THE CARE OF THE GERIATRIC PATIENT. F.U. Steinberg. 518 PP. The CV. Mosby Company. St. Louis. 1976. $31 DEVELOPMENT OF VACCINES FOR FERTILITY REGULATION. Papers presented at the WHO-sponsored Session of the Third International Symposium on Immunology of Reproduction, Varna. Bul.aria. Sept. 1975. 142 pp. lIlust. WHO and cri Ptor. Copenhagen. 1976 DISORDERS OF THE GASTROINTESTINAL TRACT: DISORDERS OF THE LIVER: NUTRITIONAL DIS. ORDERS. J.M. Dietschy. 418 pp. Illust. Grune & Stratton, Inc.. New York; Longman Canada Limited. Toronto, 1976. $28.25 DRUG LAG. FEDERAL GOVERNMENT DECISION MAKING. Edited by Rita Ricardo Campbell. 62 pp. Hoover Institution Press, Stanford, 1976 EXAMINATION IN MEDICINE. P.R. Fleming, PH. Sanderson, J.F. Stokes and H.J. Walton, 115 pp. Churchill Livingstone. Edinburgh; Longman Canada Limited, Toronto, 1976. $4.25
IndIcations and Clinical Ussa: Ibuprofen is indicated for the treatment of osteoarthritis and rheumatoid arthritia. Contraindicatlons: Ibuprofen should not be uaed during pregnancy or in pmdiatric patienta becauae ita aafety under theae conditiona haa not been eatablished. Ibuprofen should not be used in patienta with a hiatory of acetylsalicylic acidinduced bronchospasm. Precautions: Ibuprofen ahould be used with caution in patienta with a hiatory of gastrointeatinal ulceration. Ibuprofen haa been reported to be aaaociated with toxic amblyopia. Therefore precautiona ahould be taken to enaure that patienta on ibuprofen therapy report to their phyaiciana for full ophthalmological examination if they experience any viaual difficulty. Medication ahould be diacontinued if there ia any evidence of toxic amblyopia. Adverse ReactIons: The following adverae reactiona have been noted in patienta treated with ibuprofen. Gesfroinfesfinal: Nauaea, vomiting, diarrhraa, conatipation, dyapepaia, epigaatric pain and guaiac poaitive stools have been noted. A few caaea of gaatric or duodenal ulceration, Including aome complicated by bleeding or perforation have occurred. Cenfral Nervous Sysfem: Dizzineaa, light-head.. edneaa, headache, anxiety, mental confuaion and depreaaion were noted in aome patienta treated with ibuprofen. Ophfhalmologlcal: Blurred viaion waa noted In aome patienta and rarely a aenaation of moving lighta waa obaerved following adminiatration of ibuprofen. In addition there are three publiahed caaea of toxic amblyopia asaociated with the uae of ibuprofen. Although a definite cauae and effect relationahip waa not eatablished, the attending phyalciana conaidered them to be drug related. The condition waa characterized by reduced viaual acuity and difficulty in colour diacrimination. Defecta (uaually centroctacal) were obaerved on viaual field examination. Symptoma were reveraible on diacontinuatlon of treatment. Skin: Maculopapular rashes, urticaria, and generalized pruritua have been reported with ibuproten therapy. Occaaional cases of radema have also been reported. Laborafory Teafa: Sporadic abnormalitiea of liver function teata have occurred in patienta on ibuprofen therapy (SGOT, aerum bilirubin and alkaline phosphataae) but no definite trend waa aeen indicating toxicity. Similar abnormalitiea of white blood count and blood urea determinationa were noted. A alight fall in hwmoglobin and hmmatocrit haa been noted in aome patienta. Symptoms and Treatment of Overdosag.: One caae of overdoaage haa been reported. A oneyear-old child ingeated 1200 mg ibuprofen and auffered no ill effecta other than being droway the next day. Blood levels of ibuprofen reached 711 mcg/ml, which Is conaiderably above the 90 mcg/ml previously recorded aa the higheat level aeen in adults after a aingle oral doae of 800 mg. The SGPT level, nine daya poat-ingestion, waa 72. No apecific antidote ia known. Standard meaaurea to atop further abaorption and maintain urine output ahould be Implemented at once. The drug ia excreted rapidly and excretion Is almoat complete In aix houra. Dosage and AdmInIstratIon: To obtain rapid reaponae at the atart of treatment, particularly when tranaferring from other anti-inflammatory therapy, Motrin ahould be given at a dose of 1200 mg per day in 4 divided doses. Depending on the therapeutic reaponae, the doae may be adjuated downward or upward keeping the 4 timea a day dos.g&achedule. The daily doae ahould not exceed 2400 mg. Maintenance therapy, once maximum reaponae ia obtained, will range from 800 to 1200 mg per day. Due to lack of clinical experience, ibuprofen ia not indicatbd for uae in children under 12 yeara of age. SupplIed: 200 mg yellow coated tableta and 300 mg white coated tablets in bottlea of 100 and 1000. 765
REGISTERED TRAOEMARK. MOTRIN
-
CER37R.5
THE UPJOHN COMPANY OF CANADA DON MILLS, ONTARIO
continued on page 782 CMA JOURNAL/OCTOBER 23, 1976/VOL. 115 715
