The parents add that they CMA is supporting their use as a don't like the tone of doctor-bash- means of preventing the spread of ing that they read in the newspa- a virus that is much smaller than pers or the lawsuits physicians get sperm. As doctors, when we preinvolved in. They state that since I won't discourage anyone, per- scribe a treatment, we want to haps they will hear of a student in have scientific evidence that it is Canada acquiring AIDS, as has effective and that the side effects happened in the United States, are not excessive. Condoms are and that will be the factor that not effective and have the severe turns their child against medicine side effect of giving our young people the implied powerful mesas a career. It goes without saying that I sage that sexual promiscuity is was startled, but the panic in the okay. "Pushing" condoms is more area in which I practise is unbe- likely to increase sexual activity lievable. In a small rural area 20 than to decrease the spread of or more teenaged girls are infected AIDS. I would like to have seen an with HIV. I had to admit that I had heard of successful lawsuits in article on abstinence and its benethe United States by residents and ficial side effects in helping teeninterns who had acquired the agers control their premature sexvirus in a learning situation, but I ual urges until they are able to could offer no information on the express them in a responsible situation in Canada. All I could fashion. offer was that I was sure that there would be new technologies and Willi D. Gutowski, MD 101 -9181 Main St. protections built in and that per- Chilliwack, BC haps taking life a day at a time and a year at a time would make the years from 18 to 32 not seem too long; however, it was definitely not my place to be part of a scheme to keep their children Treatment of chronic from applying to medical school. Raymond Shandera, MD PO Box 716 Bay Roberts, Nfld.
The special section on AIDS in the Feb. 1 issue was a great disappointment to me. It again showed that the medical profession in Canada is regarding this serious issue in a manner that is becoming less and less scientific and more and more political. In particular, "After 10 years of AIDS, safe-sex message still controversial" is not only purely political but downright offensive. Where is the evidence that using condoms is going to ensure safe sex? It is my understanding that even for birth control condoms are one of the least effective methods, and yet it appears that the 1694
CAN MED ASSOC J 1992; 146 (10)
asthma in children: the changing role of inhaled corticosteroids
T n he position statement from the Allergy Section of the
Canadian Paediatric Society (Can Med Assoc J 1992; 145: 637-638) provides an excellent overview of the treatment of chronic asthma in children. Unfortunately, it includes a misleading statement that I wish to correct, namely that nedocromil sodium seems to be no more effective than sodium cromoglycate (cromolyn sodium) and that it is more likely to produce adverse effects. In Canada nedocromil sodium is approved for use in patients over the age of 12 years. The bulk
of clinical trials to date have been in adults. The clinical trials pro-
gram for children under 12 years of age is ongoing; thus, for this age group it is premature to draw any definite conclusions about the relative efficacy or safety of nedocromil sodium versus sodium cromoglycate. Studies designed specifically to compare nedocromil sodium with sodium cromoglycate have not been carried out. However, the two compounds have been directly compared in asymptomatic asthmatic patients in a clinical pharmacology laboratory setting. Against challenges mediated through inflammatory or neuronal pathways nedocromil sodium is more effective than sodium cromoglycate. 1'2 Bronchial provocation challenges in which bronchoconstriction is effected through mast cell degranulation have demonstrated nedocromil sodium and sodium cromoglycate to be equally effective.3 In other mast cell
degranulation studies nedocromil sodium was found to be 4 to 10 times more potent than sodium cromoglycate.4,5 There is absolutely no justification for the statement that nedocromil sodium is more likely to produce adverse effects than sodium cromoglycate. Cumulative experience from clinical studies involving several thousand patients over the age of 12 years and from 5 years of worldwide postmarketing surveillance suggests that nedocromil sodium, like sodium cromoglycate, has a remarkably good safety profile (Fisons Pharmaceuticals: data on file). Indeed, since the introduction of nedocromil sodium the rate of reporting of adverse events has been extremely low, and to date no idiosyncratic effects have been detected. The only adverse events clearly attributable to this drug are headache and nausea (Fisons Pharmaceuticals: data on file). In summary, for patients under 12 years of age there are insufficient data to permit the drawing of any definite concluLE 15 MAI 1992
The special section on AIDS in the Feb. 1 issue was a great disappointment to me. It again showed that the medical profession in Canada is regarding this serious issue in a manner that is becoming less and less scientific and more and more political. In particular, "After 10 years of AIDS, safe-sex message still controversial" is not only purely political but downright offensive. Where is the evidence that using condoms is going to ensure safe sex? It is my understanding that even for birth control condoms are one of the least effective methods, and yet it appears that the 1694
CAN MED ASSOC J 1992; 146 (10)
asthma in children: the changing role of inhaled corticosteroids
T n he position statement from the Allergy Section of the
Canadian Paediatric Society (Can Med Assoc J 1992; 145: 637-638) provides an excellent overview of the treatment of chronic asthma in children. Unfortunately, it includes a misleading statement that I wish to correct, namely that nedocromil sodium seems to be no more effective than sodium cromoglycate (cromolyn sodium) and that it is more likely to produce adverse effects. In Canada nedocromil sodium is approved for use in patients over the age of 12 years. The bulk
of clinical trials to date have been in adults. The clinical trials pro-
gram for children under 12 years of age is ongoing; thus, for this age group it is premature to draw any definite conclusions about the relative efficacy or safety of nedocromil sodium versus sodium cromoglycate. Studies designed specifically to compare nedocromil sodium with sodium cromoglycate have not been carried out. However, the two compounds have been directly compared in asymptomatic asthmatic patients in a clinical pharmacology laboratory setting. Against challenges mediated through inflammatory or neuronal pathways nedocromil sodium is more effective than sodium cromoglycate. 1'2 Bronchial provocation challenges in which bronchoconstriction is effected through mast cell degranulation have demonstrated nedocromil sodium and sodium cromoglycate to be equally effective.3 In other mast cell
degranulation studies nedocromil sodium was found to be 4 to 10 times more potent than sodium cromoglycate.4,5 There is absolutely no justification for the statement that nedocromil sodium is more likely to produce adverse effects than sodium cromoglycate. Cumulative experience from clinical studies involving several thousand patients over the age of 12 years and from 5 years of worldwide postmarketing surveillance suggests that nedocromil sodium, like sodium cromoglycate, has a remarkably good safety profile (Fisons Pharmaceuticals: data on file). Indeed, since the introduction of nedocromil sodium the rate of reporting of adverse events has been extremely low, and to date no idiosyncratic effects have been detected. The only adverse events clearly attributable to this drug are headache and nausea (Fisons Pharmaceuticals: data on file). In summary, for patients under 12 years of age there are insufficient data to permit the drawing of any definite concluLE 15 MAI 1992
