The data in the scientific literature indicate that there are few benefits in terms of weight control that can be attributed to saccharin. There are other artificial sweeteners (e.g., aspartame) being evaluated that may replace saccharin in the near future; cyclamates are also being reevaluated. In the meantime saccharin will still be available for Dr. Mayer's diabetic patients. Saccharin will be phased out of foods and cosmetics and as a nonmedical ingredient in certain drugs but will continue to be available in pharmacies on a nonprescription basis. J.S. BENNETr, MB, FRC5[C], FACOG 1.irector Professional Affairs Canadian Medical Association
Herbicides and spina bifida To the editor: A great deal of publicity has been given by the media to an alleged association between spraying with phenoxy herbicides and neuraltube defects such as spma bifida, particularly in the Gulf Islands, British Columbia. Undoubtedly regular spraying by BC Hydro has contaminated the supply of drinking water of many residents who depend on natural creeks, pools and wells. Despite the assertions by media and environmental groups that an epidemic exists, we are aware of only one case of an open neuraltube defect - an encephalocele in an infant born on one of the Gulf Islands - in the last 5 years. The mother was in contact with potentially contaminated water during the early part of her pregnancy. The other children reported to have spina bifida do not have spina bifida cystica and are normal in every respect. It is possible that they have spina bifida occulta. However, in none of them has radiography been done and it is probable that the children have nothing more than sacral dimples. Two children were reported to have palpable defects of the sacrum at the time of birth but these defects are not present now and it is likely that they represent the transient deficiency in sacral neural arches, which continue to develop after birth. It is important that monitoring of birth defects be continued and that the agencies that are spraying keep open records of the areas, dates and amounts involved. Ideally monitoring of birth defects should extend to the products of spontaneous abortions, for this could give potentially 6 months' warning of an environmental disaster. We are not suggesting that phenoxy herbicides are not harmful to health or that they are completely innocuous with respect to mutations and cancer. How-
ever, to the best of our knowledge there are no adequate reports linking these agents with the occurrence of birth defects in human beings. These agents are noxious for certain species (e.g., hamsters), but there is a tremendous difference between species. Studies in Vietnam did not prove that there was an increase in various types of malformation following spraying and bombing. To our knowledge there has been only one report of defects in humans: two infants with a neural-tube defect were born within a month of each other; the families, who gathered the domestic water supply from the roof, lived on adjoining farms that had been sprayed with 2,4,5-trichlorophenoxyacetic acid. We emphasize that the words cystica or occulta be used when spina bifida is discussed. The Canadian Broadcasting Corporation's program "Fifth Estate" did not differentiate the two groups and hence was misleading, causing many patients to be unnecessarily apprehensive. None of the patients referred to in this program who were alleged to have spina bifida had spina bifida cystica; since radiographs had not been taken one could not be certain that they even had spina bifida occulta. R... LOWRY, MB, B CH, FRcP[c] Associate professor Department of medical genetics University of British Columbia Vancouver, BC and medical consultant Health surveillance registry Ministry of Health Victoria, BC A.B. ALLEN, MB, B5, DPH Deputy regional health officer Capital Regional District Victoria, BC Reference 1. SARa WM, FORBES P1: Possible dysmorphogenic effects of an agricultural chemical: 2.4.5-T. NZ Med J 75: 37, 1972
The cost of cigarettes as compared with physicians. services To the editor: About 50% of adults in Ontario smoke. Hence the average family of three that includes a pack-aday cigarette smoker will spend about $350 per year on cigarettes - that is, about $100 per person per year. Last year the Ontario Health Insurance Plan paid $800 million to doctors; this also averages out to about $100 per person per year. (There are about 7 million residents in Ontario.) Wake up, colleagues! You and the public are being brainwashed into believing that our services are less valuable to society than cigarettes.
580 CMA JOURNAL/SEPTEMBER 17, 1977/VOL. 117
LOUIS TRAIN, MD 1260 Lawrence Ave. W Don Mills, Ont.
Locasalen (flumethasone pivalate/salicylic acid)
topical corticosteroid! squamolytic Indications LOCASALEN is intended for the treatment of subacute to hyperchronic inftammatory and/or dysplastic skin diseases, as well as hyperkeratotic conditions in particular. The indications for LOCASALEN thus include chronic constitutional eczema or neurodermatitis; chronic exogenous eczema irrespective of origin, (e.g.: skin disorders due to attrition, occupational eczema); chronic eczema of microbial or mycotic origin; tylotic eczema; hyperkeratosis as encountered in ichthyosis or chronic dyshidrosis; pustulosis of the palms and soles; lichen planus; chronic cutaneous lupus erythematosus; paoriasis.
Contraindications Tuberculosis of the skin, syphilitic skin affections, viral and acute fungal infections of the skin. Systemic fungal infections. This preparation is not for ophthalmic use. LOCASALEN is contraindicated in individuals with a history of hypersensitivity to its components.
Adverse Reactions
The local tolerability of LOCASALEN proved to be very good. Cases in which local irritation made it advisable to discontinue the medication accounted for less than 2% of the total number of patients treated. Adverse reactions consist mainly of local reddening of the skin, desquamation, pruritis and smarting. LOCASALEN contains no preservatives, odour correcting agents, emulsifiers, stabilizers or antibiotic supplements which have been recognized as potential sensitizers. Hypersensitivity to salicytic acid can occur; however, the incidence in the population as a whole is approximately 0.2%. Systemic side effects attributable to the transcutaneous absorption of salicylic acid or flumethasone pivalate have not been reported. Absorption of salicylic acid does occur; however, investigations have shown that irrespective of the amount of LOCASALEN employed, and even applied under occlusive dressings, plasma concentrations of salicylic acid did not exceed ordinary therapeutic levels as a result of transcutaneous absorption. Investigations have shown that under extreme conditions-where 40 to 60 grams of ointment were applied daly to 80-90%of the body surface under occlusive dressings-plasma cortisol and urinary steroids have been observed to decrease below normal levels. This decrease proved transitory and was not accompanied by any clinical symptoms.
Precautions If sensitivity or idiosyncratic reactions occur, LOCASALEN should be discontinued and appropriate measures taken. The safely of the use of topical corticosteroids in pregnant females has not been established. Therefore they should not be used extensively on pregnant patients in large amounts or for prolonged periods of time. Patients should be advised to inform subsequent physicians of the prior use of corticosteroids. In the presence of an infection, the use of an appropriate antifungal or antibecterial agent should be instituted, If a favourable response does not occur promptly, LOCASALEN should be discontinued until the infection has been edequately controlled.
Warnings
LOCASALEN is not indicated in acute weeping or subscute exudative stages. As transcutaneous absorption of the salicytic acid component may give rise to systemic effects, LOCASALEN should not be applied to extensive areas of the skin in small children or pregnant women. Likewise corticosteroids are known to be absorbed percutaneousiy, therefore in patients requiring applications of LOCASALEN to extensive areas or for prolonged periods, adrenal function should be carefully monitored. All contact of the drug with the eyes, mouth, mucous membranes should be avoided.
Dosage and Administration
As a rule LOCASALEN should be applied once or twice daily when dressings are not used and once daily when employed under occlusive dressing. It is not usually necessary to cover the treated area. The thickness of the layer should vary depending on the nature and severity of the skin disorder, since in this way, it is possible to regulate moisture retention. In cases in which transitory exudative must be anticipated, LOCASALEN should be applied in a very thin layer, thereby allowing larger quantities of moisture to be released through the film of ointment. LOCASALEN can also exert an occlusive effect but only it applied in a thick layer. It penetrates well into the skin and when rubbed in thoroughly, leaves on the skin a transparent, oily film that can be removed with soap and water or a skin cleanser. Excess film can be removed relatively well with paper tissue, scarcely leaving any perceptible sheen.
Supplied
Flumethasone Pivalate 0.02% and salicylic acid 3.0% ointmentintubesof 15gm and 50 gin.
Reference: 1. Jenny, D., Schuppli, R.: Progress in the Treatment of Eczema, Praxix 59: 589,1970. Full information available on request
CIBA DORVAL, H95 181
QUEBEC
C-6035R
Herbicides and spina bifida To the editor: A great deal of publicity has been given by the media to an alleged association between spraying with phenoxy herbicides and neuraltube defects such as spma bifida, particularly in the Gulf Islands, British Columbia. Undoubtedly regular spraying by BC Hydro has contaminated the supply of drinking water of many residents who depend on natural creeks, pools and wells. Despite the assertions by media and environmental groups that an epidemic exists, we are aware of only one case of an open neuraltube defect - an encephalocele in an infant born on one of the Gulf Islands - in the last 5 years. The mother was in contact with potentially contaminated water during the early part of her pregnancy. The other children reported to have spina bifida do not have spina bifida cystica and are normal in every respect. It is possible that they have spina bifida occulta. However, in none of them has radiography been done and it is probable that the children have nothing more than sacral dimples. Two children were reported to have palpable defects of the sacrum at the time of birth but these defects are not present now and it is likely that they represent the transient deficiency in sacral neural arches, which continue to develop after birth. It is important that monitoring of birth defects be continued and that the agencies that are spraying keep open records of the areas, dates and amounts involved. Ideally monitoring of birth defects should extend to the products of spontaneous abortions, for this could give potentially 6 months' warning of an environmental disaster. We are not suggesting that phenoxy herbicides are not harmful to health or that they are completely innocuous with respect to mutations and cancer. How-
ever, to the best of our knowledge there are no adequate reports linking these agents with the occurrence of birth defects in human beings. These agents are noxious for certain species (e.g., hamsters), but there is a tremendous difference between species. Studies in Vietnam did not prove that there was an increase in various types of malformation following spraying and bombing. To our knowledge there has been only one report of defects in humans: two infants with a neural-tube defect were born within a month of each other; the families, who gathered the domestic water supply from the roof, lived on adjoining farms that had been sprayed with 2,4,5-trichlorophenoxyacetic acid. We emphasize that the words cystica or occulta be used when spina bifida is discussed. The Canadian Broadcasting Corporation's program "Fifth Estate" did not differentiate the two groups and hence was misleading, causing many patients to be unnecessarily apprehensive. None of the patients referred to in this program who were alleged to have spina bifida had spina bifida cystica; since radiographs had not been taken one could not be certain that they even had spina bifida occulta. R... LOWRY, MB, B CH, FRcP[c] Associate professor Department of medical genetics University of British Columbia Vancouver, BC and medical consultant Health surveillance registry Ministry of Health Victoria, BC A.B. ALLEN, MB, B5, DPH Deputy regional health officer Capital Regional District Victoria, BC Reference 1. SARa WM, FORBES P1: Possible dysmorphogenic effects of an agricultural chemical: 2.4.5-T. NZ Med J 75: 37, 1972
The cost of cigarettes as compared with physicians. services To the editor: About 50% of adults in Ontario smoke. Hence the average family of three that includes a pack-aday cigarette smoker will spend about $350 per year on cigarettes - that is, about $100 per person per year. Last year the Ontario Health Insurance Plan paid $800 million to doctors; this also averages out to about $100 per person per year. (There are about 7 million residents in Ontario.) Wake up, colleagues! You and the public are being brainwashed into believing that our services are less valuable to society than cigarettes.
580 CMA JOURNAL/SEPTEMBER 17, 1977/VOL. 117
LOUIS TRAIN, MD 1260 Lawrence Ave. W Don Mills, Ont.
Locasalen (flumethasone pivalate/salicylic acid)
topical corticosteroid! squamolytic Indications LOCASALEN is intended for the treatment of subacute to hyperchronic inftammatory and/or dysplastic skin diseases, as well as hyperkeratotic conditions in particular. The indications for LOCASALEN thus include chronic constitutional eczema or neurodermatitis; chronic exogenous eczema irrespective of origin, (e.g.: skin disorders due to attrition, occupational eczema); chronic eczema of microbial or mycotic origin; tylotic eczema; hyperkeratosis as encountered in ichthyosis or chronic dyshidrosis; pustulosis of the palms and soles; lichen planus; chronic cutaneous lupus erythematosus; paoriasis.
Contraindications Tuberculosis of the skin, syphilitic skin affections, viral and acute fungal infections of the skin. Systemic fungal infections. This preparation is not for ophthalmic use. LOCASALEN is contraindicated in individuals with a history of hypersensitivity to its components.
Adverse Reactions
The local tolerability of LOCASALEN proved to be very good. Cases in which local irritation made it advisable to discontinue the medication accounted for less than 2% of the total number of patients treated. Adverse reactions consist mainly of local reddening of the skin, desquamation, pruritis and smarting. LOCASALEN contains no preservatives, odour correcting agents, emulsifiers, stabilizers or antibiotic supplements which have been recognized as potential sensitizers. Hypersensitivity to salicytic acid can occur; however, the incidence in the population as a whole is approximately 0.2%. Systemic side effects attributable to the transcutaneous absorption of salicylic acid or flumethasone pivalate have not been reported. Absorption of salicylic acid does occur; however, investigations have shown that irrespective of the amount of LOCASALEN employed, and even applied under occlusive dressings, plasma concentrations of salicylic acid did not exceed ordinary therapeutic levels as a result of transcutaneous absorption. Investigations have shown that under extreme conditions-where 40 to 60 grams of ointment were applied daly to 80-90%of the body surface under occlusive dressings-plasma cortisol and urinary steroids have been observed to decrease below normal levels. This decrease proved transitory and was not accompanied by any clinical symptoms.
Precautions If sensitivity or idiosyncratic reactions occur, LOCASALEN should be discontinued and appropriate measures taken. The safely of the use of topical corticosteroids in pregnant females has not been established. Therefore they should not be used extensively on pregnant patients in large amounts or for prolonged periods of time. Patients should be advised to inform subsequent physicians of the prior use of corticosteroids. In the presence of an infection, the use of an appropriate antifungal or antibecterial agent should be instituted, If a favourable response does not occur promptly, LOCASALEN should be discontinued until the infection has been edequately controlled.
Warnings
LOCASALEN is not indicated in acute weeping or subscute exudative stages. As transcutaneous absorption of the salicytic acid component may give rise to systemic effects, LOCASALEN should not be applied to extensive areas of the skin in small children or pregnant women. Likewise corticosteroids are known to be absorbed percutaneousiy, therefore in patients requiring applications of LOCASALEN to extensive areas or for prolonged periods, adrenal function should be carefully monitored. All contact of the drug with the eyes, mouth, mucous membranes should be avoided.
Dosage and Administration
As a rule LOCASALEN should be applied once or twice daily when dressings are not used and once daily when employed under occlusive dressing. It is not usually necessary to cover the treated area. The thickness of the layer should vary depending on the nature and severity of the skin disorder, since in this way, it is possible to regulate moisture retention. In cases in which transitory exudative must be anticipated, LOCASALEN should be applied in a very thin layer, thereby allowing larger quantities of moisture to be released through the film of ointment. LOCASALEN can also exert an occlusive effect but only it applied in a thick layer. It penetrates well into the skin and when rubbed in thoroughly, leaves on the skin a transparent, oily film that can be removed with soap and water or a skin cleanser. Excess film can be removed relatively well with paper tissue, scarcely leaving any perceptible sheen.
Supplied
Flumethasone Pivalate 0.02% and salicylic acid 3.0% ointmentintubesof 15gm and 50 gin.
Reference: 1. Jenny, D., Schuppli, R.: Progress in the Treatment of Eczema, Praxix 59: 589,1970. Full information available on request
CIBA DORVAL, H95 181
QUEBEC
C-6035R
